Barbieri Lucia, Verdoia Monica, Schaffer Alon, Nardin Matteo, Marino Paolo, De Luca Giuseppe
Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Corso Mazzini, 18, 28100, Novara, Italy.
J Thromb Thrombolysis. 2014 Nov;38(4):493-502. doi: 10.1007/s11239-014-1076-3.
Contrast induced nephropathy (CIN) is a common complication of coronary angiography/angioplasty. Prevention is the key to reduce the incidence of CIN and it begins with appropriate pre-procedural management. Statins have been shown to possess pleiotropic effects (anti-oxidant, anti-inflammatory and anti-thrombotic properties) and their effects on CIN were assessed in several studies with conflicting results. Aim of this meta-analysis is to evaluate the efficacy of short-term statins for the prevention of CIN in patients undergoing coronary angiography/percutaneous interventions. We performed formal searches of PubMed, EMBASE, Cochrane central register of controlled trials and major international scientific session abstracts from January 1990 to January 2014 of trials which compares short-term statins versus Placebo for the prevention of CIN in patients undergoing coronary angiography/angioplasty. Data regarding study design, statin dose, inclusion/exclusion criteria, number of patients, and clinical outcome was extracted by 2 investigators. Eight trials were included, with a total of 4734 patients. CIN occurred in 79/2,358 patients (3.3%) treated with statins versus 153/2,376 patients (6.4%) of the placebo group [OR 95% CI 0.50 (0.38-0.66), p < 0.00001; p het = 0.39]. Benefits were both observed with high-dose short-term statins [OR 95% CI 0.44 (0.30-0.65), p < 0.0001; p het = 0.16] and low-dose statins, [OR 95% CI 0.58 (0.39-0.88), p = 0.010; p het = 0.90]. By meta-regression analysis, no significant relationship was observed between benefits from statin therapy and patient's risk profile (p = 0.26), LDL cholesterol (p = 0.4), contrast volume (p = 0.94) or diabetes rate (p = 0.38). This meta-analysis showed that among patients undergoing coronary angiography/percutaneous intervention the use of short-term statins reduces the incidence of CIN, and therefore is highly recommended even in patients with low LDL-cholesterol levels.
对比剂肾病（CIN）是冠状动脉造影/血管成形术常见的并发症。预防是降低CIN发生率的关键，且预防始于适当的术前管理。他汀类药物已被证明具有多效性（抗氧化、抗炎和抗血栓形成特性），并且在多项研究中评估了它们对CIN的影响，结果相互矛盾。本荟萃分析的目的是评估短期使用他汀类药物对接受冠状动脉造影/经皮介入治疗患者预防CIN的疗效。我们对1990年1月至2014年1月期间比较短期使用他汀类药物与安慰剂预防接受冠状动脉造影/血管成形术患者发生CIN的试验，在PubMed、EMBASE、Cochrane对照试验中央注册库以及主要国际科学会议摘要中进行了正式检索。两名研究人员提取了有关研究设计、他汀类药物剂量、纳入/排除标准、患者数量和临床结局的数据。纳入了八项试验，共4734例患者。接受他汀类药物治疗的2358例患者中有79例（3.3%）发生CIN，而安慰剂组的2376例患者中有153例（6.4%）发生CIN [比值比95%置信区间0.50（0.38 - 0.66），p < 0.00001；异质性p = 0.39]。高剂量短期他汀类药物[比值比95%置信区间0.44（0.30 - 0.65），p < 0.0001；异质性p = 0.16]和低剂量他汀类药物[比值比95%置信区间0.58（0.39 - 0.88），p = 0.010；异质性p = 0.90]均观察到有益效果。通过荟萃回归分析，未观察到他汀类药物治疗的益处与患者风险概况（p = 0.26）、低密度脂蛋白胆固醇（p = 0.4）、对比剂用量（p = 0.94）或糖尿病发生率（p = 0.38）之间存在显著关系。本荟萃分析表明，在接受冠状动脉造影/经皮介入治疗的患者中，短期使用他汀类药物可降低CIN的发生率，因此即使在低密度脂蛋白胆固醇水平较低的患者中也强烈推荐使用。
