Zhou Y, Yuan W J, Zhu N, Wang L
Department of Nephrology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Clin Nephrol. 2011 Dec;76(6):475-83. doi: 10.5414/cn106950.
There have been conflicting reports on the use of statins for prevention of contrast-induced nephropathy (CIN). The aim of this study was to assess the effectiveness of short-term (2 - 7 days), high-dose (80 mg/d) statins in the prevention of CIN. STUDY DESIGN, SETTING AND PARTICIPANTS: Randomized controlled trials assessing the preventive effect of short-term, highdose statins on CIN (published from 1966 to 2010) were searched.
Quality of the trials was evaluated with the assessing risk of bias in studies included in the Cochrane reviews.
CIN is the primary endpoint of the study.
Meta-regression and a fixed-effects model were used for analyses.
Five trials with a total of 1,009 patients were identified, with the overall effect of statins showing benefit for preventing CIN (relative risk (RR) = 0.53, 0.32 - 0.87). Meta-regression showed the existence of minor heterogeneity (I² = 19%) could be largely accounted for by baseline serum creatinine. Two studies conducted in patients with CKD Stage ≥ 3 did not reveal a statistically significant difference in CIN incidence between the statin and placebo groups (6.5% vs. 7.2%) (RR = 0.89, 0.46 - 1.73), without evidence of heterogeneity (I² = 0%, p = 0.79). The remaining three studies conducted in patients with CKD Stage > 3 revealed a significantly lower CIN incidence in the statin groups (3.6% vs. 11.9%) (RR = 0.28, 0.13 - 0.62), without evidence of heterogeneity (I2 = 0%, p = 0.87).
The overall effect of shortterm, high-dose statin treatment seems to be helpful for prevention of CIN. However, the subgroup analysis shows statin benefit only in patients with CKD Stage > 3, but not in patients with CKD Stage ≤ 3.
The relative low quality of the individual studies and limited studies means that only a limited conclusion on the use of statin for prevention of CIN was possible.
关于他汀类药物用于预防造影剂肾病（CIN）的报道存在矛盾。本研究的目的是评估短期（2 - 7天）、高剂量（80毫克/天）他汀类药物预防CIN的有效性。研究设计、设置和参与者：检索了评估短期、高剂量他汀类药物对CIN预防效果的随机对照试验（发表于1966年至2010年）。
采用Cochrane综述中纳入研究的偏倚风险评估方法评估试验质量。
CIN是本研究的主要终点。
采用Meta回归和固定效应模型进行分析。
共纳入5项试验，总计1009例患者，他汀类药物的总体效果显示对预防CIN有益（相对危险度（RR）=0.53，0.32 - 0.87）。Meta回归显示存在轻度异质性（I² = 19%），这在很大程度上可由基线血清肌酐解释。两项在慢性肾脏病（CKD）3期及以上患者中进行的研究未显示他汀类药物组和安慰剂组在CIN发生率上有统计学显著差异（6.5%对7.2%）（RR = 0.89，0.46 - 1.73），无异质性证据（I² = 0%，p = 0.79）。其余三项在CKD 3期以上患者中进行的研究显示他汀类药物组的CIN发生率显著更低（3.6%对11.9%）（RR = 0.28，0.13 - 0.62），无异质性证据（I² = 0%，p = 0.87）。
短期、高剂量他汀类药物治疗的总体效果似乎有助于预防CIN。然而，亚组分析显示他汀类药物仅对CKD 3期以上患者有益，对CKD 3期及以下患者无益。
各研究质量相对较低且研究数量有限，这意味着关于他汀类药物用于预防CIN只能得出有限的结论。
