摘要
目的综合分析西那卡塞治疗透析患者继发性甲状旁腺功能亢进症(SHPT)的有效性与安全性。方法计算机检索Pubmed、Embase、Cochrane Library、OVID、中国知网、中国生物医学文献数据库、万方数据库,时间为建库至2017年12月,获得有关西那卡塞治疗透析患者SHPT的随机对照试验。由2名评价员独立对纳入的文献进行数据提取和质量评价,用Rev Man 5.3.5软件进行Meta分析。结果共纳入18篇随机对照试验,合计8 194例患者。Meta分析结果显示,相比对照组方案,西那卡塞可显著降低SHPT患者甲状旁腺素水平(MD=-239.33,95%CI-289.81～-258.7,P<0.05),成纤维细胞生长因子23水平(MD=-303.62,95%CI-400.15～-207.10,P<0.05),降低血钙(MD=-0.87,95%CI-1.00～-0.75,P<0.05),降低血磷(MD=-0.30,95%CI-0.32～-0.28,P<0.05),降低钙磷乘积(MD=-8.75,95%CI-10.09～-7.40,P<0.05);西那卡塞组与对照组相比,更易发生恶心(RR=1.60,95%CI 1.35～1.89,P<0.05)、呕吐(RR=1.89,95%CI 1.56～2.30,P<0.05)、腹泻(RR=1.54,95%CI 1.14～2.07,P<0.05)、低钙血症(RR=7.41,95%CI 4.92～11.16,P<0.05),而全因病死率(RR=0.98,95%CI 0.90～1.06,P>0.05)的差异无统计学意义。结论西那卡塞可有效降低透析患者继发性甲状旁腺功能亢进症甲状旁腺素、成纤维细胞生长因子23、钙、磷、钙磷乘积水平,不能影响患者全因病死率,有增加恶心、呕吐、腹泻、低钙血症的风险。
Objective To evaluate the efficacy and safety of cinacalcet in the treatment of dialysis patients with seondary hyperparathyroidism. Methods Retrieved from Pumed,Embase,Cochrane Library,OVID, CNKI, SinoMed, Wanfang data-base. The limited range was from the establishment of this database to March 2017, Get the randomized controlled trials about cinacalcet in the treatment of dialysis patients with secondary hyperparathyroidism. Data were extractedand evaluated by two reviewers independently, and meta-analysis was performed with RevMan 5.3.5. Results A total of 18 randomized controlled trials involving 8194 patients were included. The meta-analysis showed that compared with conventional therapy, cinacalcet cansignificantly decrese parathyroid hormone in SHPT patients, and decrease the level of FGF2 3, decrease the level of serum calcium, decrease the level of serum phosphrus, decrease the level of Ca × P, Compared with the control group,the patient of the cinacalcet group was more prone to nausea, vomiting,diarrhea and hypocalcemia,it showed no statistical significance of the difference of all-cause mortality. Conclusions Cinacalcet can effectively reduce the level of PTH,FGF2 3, calcium, phosphorus and Ca × P in dialysis patients with secondary hyperparathyroidism and can not reduce the risk of all-cause mortality;increase the risk of nausea, vomiting, diarrhea and hypocalcemia.
作者
吕缘
徐承云
LV Yuan;XU Cheng-yun(Department of nephrology,The Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《临床肾脏病杂志》
2018年第8期460-465,共6页
Journal Of Clinical Nephrology
基金
江西省重点研发计划(No.S2017YBYFE0953)
