摘要
目的探讨短期（2～7d）大剂量（80mg／d）他汀类药物对冠状动脉（冠脉）造影患者发生对比剂肾病（CIN）的预防作用。方法以“statins／statin／HMG—CoA reductase inhibitor”、“contrast”和“nephropathy／nephrosis／nephrotoxicity／kidneyfailure”为关键词，查找1966年至2010年PubMed、Embase、Science Direct、Wiley Inter Science、Scopus和Ovid数据库的RCT，无语言限制。2位评价者评价每一项研究的质量并提取数据。结果5项RCT共计1009例患者被纳入研究。按血肌酐（SCr）水平进行分层研究显示，慢性肾脏病（CKD）3—5期（GFR≤60ml／min或SCr≥97．2μmol／L）患者使用他汀类药物后CIN的发生率差异没有统计学意义（治疗组6．5％比对照组7．2％，RR=0．89），且人选研究没有异质性（I2=0％，P=0．79）；CKD1～2期（GFR〉60ml／min）患者使用他汀类药物CIN的发生率显著低于对照组，差异有统计学意义（治疗组3．6％比对照组11．9％，RR=0．28），入选研究也无异质性（I2=0％，P=0．87）。结论短期大剂量应用他汀类药物可预防CKD1—2期冠脉造影患者CIN的发生，而对CKD3～5期的患者无显著预防作用。
Objective To assess the effects of short-term （2-7 d） high-dose （80 rag/d） statins in the prevention of contrast-induced nephropathy （CIN）. Methods We searched PubMed, Embase, ScienceDirect, Scopus, Ovid and Wiley InterScience with the key words of ＂ statins/statin/HMG-CoA reductase inhibitor＂, ＂ contrast ＂ and ＂ nephropathy/nephrosis/nephrotoxicity/kidney failure ＂ in all languages from 1996 to 2010 for RCT that assessed the preventive effect of short-term （2-7 d） high-dose （80 rag/d） statins on CIN. Results Five trials with a total of 1009 patients were identified. Two studies were conducted in patients with CKD 3-5 stages （GFR≤60 ml/min or serum creatinine≥97.2 μmol/L） and the remaining 3 studies were conducted in patients with CKD l and 2 stages. Analysis of the data in patients with CKD 3-5 stages did not reveal a statistically significant difference in CIN incidence between the statins and placebo groups （6. 5% vs 7.2% ）. The relative risk （RR） was 0. 89 without evidence of heterogeneity （12 = 0%, P = 0. 79）. Analysis of the data in patients with CKD 1 and 2 stages revealed a significantly lower CIN incidence in the statins group （3.6%） than that in the placebo group （ 11.9% ）. The RR was 0. 28 without evidence of heterogeneity （ 12 ： 0% , P = 0. 87）. Conclusion Short-term high-dose statins treatment may be benefical in reducing the incidence of CIN in patients with CKD 1 and 2 stages, while no benefit has been shown in the patients with CKD 3-5 stages.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2011年第11期942-946,共5页
Chinese Journal of Internal Medicine
