终末期肾病继发甲状旁腺功能亢进症患者使用拟钙剂的效果和安全性：一项荟萃分析。
Effects and safety of calcimimetics in end stage renal disease patients with secondary hyperparathyroidism: a meta-analysis.
机构信息
Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
出版信息
PLoS One. 2012;7(10):e48070. doi: 10.1371/journal.pone.0048070. Epub 2012 Oct 25.
PURPOSE
Secondary hyperparathyroidism (SHPT) is one of the most common abnormalities of mineral metabolism in patients with chronic kidney disease. We performed a meta-analysis to determine the effect and safety of cinacalcet in SHPT patients receiving dialysis.
METHODS
The meta-analysis was performed to determine the effect and safety of cinacalcet in SHPT patients receiving dialysis by using the search terms 'cinacalcet' or 'mimpara' or 'sensipar' or 'calcimimetic' or 'R586' on MEDLINE and EMBASE (January 1990 to February 2012).
RESULTS
Fifteen trials were included, all of which were performed between 2000 and 2011 enrolling a total of 3387 dialysis patients. Our study showed that calcimimetic agents effectively ameliorated iPTH levels(WMD, -294.36 pg/mL; 95% CI, -322.76 to -265.95, P<0.001) in SHPT patients and reduced serum calcium (WMD, -0.81 mg/dL; 95% CI, -0.89 to -0.72, P<0.001) and phosphorus disturbances(WMD, -0.29 mg/dL; 95% CI, -0.41 to -0.17, P<0.001). The percentage of patients in whom there was a 30% decrease in serum iPTH levels by the end of the dosing was higher in cinacalcet group than that in control group(OR = 10.75, 95% CI: 6.65-17.37, P<0.001). However, no significant difference was found in all-cause mortality and all adverse events between calcimimetics and control groups(OR = 0.86, 95% CI: 0.46-1.60, P = 0.630; OR = 1.30, 95% CI: 0.78-2.18, P = 0.320, respectively). Compared with the control therapy, there was a significant increase in the episodes of hypocalcemia (OR = 2.46, 95% CI: 1.58-3.82, P<0.001), nausea (OR = 2.45, 95% CI: 1.29-4.66, P = 0.006), vomiting(OR = 2.78, 95% CI: 2.14-3.62, P<0.001), diarrhea(OR = 1.51, 95% CI: 1.04-2.20, P = 0.030) and upper respiratory tract infection (OR = 1.79, 95% CI: 1.20-2.66, P = 0.004)in calcimimetics group.
CONCLUSIONS
Calcimimetic treatment effectively improved biochemical parameters of SHPT patients receiving dialysis without increasing all-cause mortality and all adverse events.
目的
继发性甲状旁腺功能亢进症（SHPT）是慢性肾脏病患者矿物质代谢最常见的异常之一。我们进行了一项荟萃分析，以确定在接受透析的 SHPT 患者中使用西那卡塞的疗效和安全性。
方法
使用 MEDLINE 和 EMBASE 上的搜索词“西那卡塞”或“mimpara”或“sensipar”或“钙敏感受体激动剂”或“R586”，对 2000 年至 2011 年间进行的确定在接受透析的 SHPT 患者中西那卡塞疗效和安全性的所有试验进行荟萃分析。
结果
共纳入 15 项试验，均在 2000 年至 2011 年间进行，共纳入 3387 例透析患者。我们的研究表明，钙敏感受体激动剂可有效改善 SHPT 患者的 iPTH 水平（WMD，-294.36 pg/mL；95%CI，-322.76 至-265.95，P<0.001），并降低血清钙（WMD，-0.81 mg/dL；95%CI，-0.89 至-0.72，P<0.001）和磷紊乱（WMD，-0.29 mg/dL；95%CI，-0.41 至-0.17，P<0.001）。与对照组相比，西那卡塞组有更多患者的血清 iPTH 水平下降 30%（OR = 10.75，95%CI：6.65-17.37，P<0.001）。然而，钙敏感受体激动剂组与对照组之间在全因死亡率和所有不良事件方面均无显著差异（OR = 0.86，95%CI：0.46-1.60，P = 0.630；OR = 1.30，95%CI：0.78-2.18，P = 0.320）。与对照组治疗相比，钙敏感受体激动剂组的低钙血症发作（OR = 2.46，95%CI：1.58-3.82，P<0.001）、恶心（OR = 2.45，95%CI：1.29-4.66，P = 0.006）、呕吐（OR = 2.78，95%CI：2.14-3.62，P<0.001）、腹泻（OR = 1.51，95%CI：1.04-2.20，P = 0.030）和上呼吸道感染（OR = 1.79，95%CI：1.20-2.66，P = 0.004）的发生率显著增加。
结论
钙敏感受体激动剂治疗可有效改善接受透析的 SHPT 患者的生化参数，而不增加全因死亡率和所有不良事件。
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