西那卡塞联合骨化三醇治疗血液透析患者继发性甲状旁腺功能亢进的Meta分析

Meta-analysis of cinacalcet plus calcitriol for the treatment of secondary hyperparathyroidism in hemodialysis patients

目的评价西那卡塞联合骨化三醇治疗透析患者继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的疗效及不良反应。方法通过计算机检索PubMed、Embase、Cochrane library、中国知网(CNKI)、万方数据库(WANFANG)、中文科技期刊数据库(VIP),纳入西那卡塞联合骨化三醇治疗透析患者SHPT的临床随机对照试验相关文献,两名研究者按照Cochrane系统评价员手册5.1.0版独立筛选文献及提取数据,采用RevMan 5.3软件进行数据处理。结果共纳入30篇文献,总样本量为2497例。Meta分析的结果:相比于单独用药组,联合用药组治疗有效率明显提高,且有效降低血清磷浓度、碱性磷酸酶、成纤维细胞生长因子23(fibroblast growth factor 23,FGF-23)、甲状旁腺激素水平及减小甲状旁腺体积。联合用药组不良反应发生率相比于单用西那卡塞组低,与骨化三醇组相比无差异;血清钙离子浓度水平相比于西那卡塞组高,与骨化三醇组相比差异无统计学意义;钙磷乘积相比于西那卡塞组高,相比于骨化三醇组低。结论基于当前证据,相比于单独用药,西那卡塞联合骨化三醇治疗血液透析患者SHPT能取得更好的临床疗效,且不良反应发生率低。

Objective To evaluate the efficacy and adverse reactions of cinacalcet plus calcitriol in the treatment of secondary hyperparathyroidism in hemodialysis patients.Methods Clinical trial of cinacalcet plus calcitriol in the treatment of secondary hyperparathyroidism in dialysis patients were retrieved from the databases of PubMed,Embase,Cochrane Library,China National Knowledge Internet,Wangfang and VIP.Two researchers independently screened the literatures and extracted the relevant data according to Cochrane Systematic Evaluator's Manual 5.1.0.The included randomized controlled trials were Meta-analyzed by RevMan5.3 software.Results A total of 30 articles were retrieved.The total sample size was 2497 people.Meta-analysis indicated that the effective rate of combined drug group significantly improved as compared with single drug group.And the effects of reducing the levels of serum phosphorus concentration,alkaline phosphatase,fibroblast growth factor 23 and parathyroid hormone and lowering parathyroid volume were more significant.The incidence of adverse reactions was lower in combined drug group than that in single cinacalcet group and there was no difference with single calcitriol group.The level of serum calcium was higher in combined drug group than single cinacalcet group and lower than that in single calcitriol group.The level of serum calcium-phosphorus product was higher in combined drug group than single cinacalcet group and lower than that in single calcitriol group.Conclusion Based upon current evidence,cinacalcet plus calcitriol in the treatment of secondary hyperparathy roidism offers a better clinical efficacy and a lower incidence of adverse reactions as compared with single medication in hemodialysis patients.