碳酸氢钠对已有肾功能不全患者预防造影剂肾病的疗效：一项荟萃分析。
The efficacy of sodium bicarbonate in preventing contrast-induced nephropathy in patients with pre-existing renal insufficiency: a meta-analysis.
作者信息
Zhang Bin, Liang Long, Chen Wenbo, Liang Changhong, Zhang Shuixing
机构信息
Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Graduate College, Guangzhou, Guangdong Province, China Southern Medical University, Guangzhou, Guangdong Province, China.
Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Graduate College, Guangzhou, Guangdong Province, China.
出版信息
BMJ Open. 2015 Mar 17;5(3):e006989. doi: 10.1136/bmjopen-2014-006989.
OBJECTIVE
The aim of this meta-analysis was to explore the efficacy of sodium bicarbonate in preventing contrast-induced nephropathy (CIN).
METHODS
We searched PubMed, Medline and the Cochrane Library from 1 January 2004 to 1 August 2014. The effect estimate was expressed as a pooled OR with 95% CI, using the fixed-effects or random-effects model.
RESULTS
20 randomised controlled trials (n=4280) were identified. Hydration with sodium bicarbonate was associated with a significant decrease in CIN among patients with pre-existing renal insufficiency (OR 0.67, 95% CI 0.47 to 0.96; p=0.027). However, moderate heterogeneity was noted across trials (I(2)=48%; p=0.008). Subgroup analyses indicated a better effect of sodium bicarbonate in studies using low-osmolar (OR 0.59, 95% CI 0.37 to 0.93; p=0.024) compared with iso-osmolar contrast agents (OR 0.76, 95% CI 0.43 to 1.34; p=0.351). The odds of CIN with sodium bicarbonate were lower in studies including only patients undergoing emergency (OR 0.16, 95% CI 0.05 to 0.51; p=0.002) compared with elective procedures (OR 0.76, 95% CI 0.54 to 1.06; p=0.105). Sodium bicarbonate was more beneficial in patients given a bolus injection before procedures (OR 0.15, 95% CI 0.04 to 0.54; p=0.004) compared with continuous infusion (OR 0.75, 95% CI 0.53 to 1.05; p=0.091). Sodium bicarbonate plus N-acetylcysteine (OR 0.17, 95% CI 0.04 to 0.79; p=0.024) was better than sodium bicarbonate alone (OR 0.71, 95% CI 0.48 to 1.03; p=0.071). The effect of sodium bicarbonate was considered greater in papers published before (OR 0.19, 95% CI 0.09 to 0.41; p=0.000) compared with after 2008 (OR 0.85, 95% CI 0.62 to 1.16; p=0.302). However, no significant differences were found in mortality (OR 0.69, 95% CI 0.36 to 1.32; p=0.263) or requirement for dialysis (OR 1.08, 95% CI 0.52 to 2.25; p=0.841).
CONCLUSIONS
Sodium bicarbonate is effective in preventing CIN among patients with pre-existing renal insufficiency. However, it fails to lower the risks of dialysis and mortality and therefore cannot improve the clinical prognosis of patients with CIN.
目的
本荟萃分析旨在探讨碳酸氢钠预防对比剂肾病（CIN）的疗效。
方法
我们检索了2004年1月1日至2014年8月1日期间的PubMed、Medline和Cochrane图书馆。效应估计值采用固定效应或随机效应模型，以合并的比值比（OR）及95%可信区间（CI）表示。
结果
共纳入20项随机对照试验（n = 4280）。对于已有肾功能不全的患者，使用碳酸氢钠进行水化治疗与CIN显著降低相关（OR 0.67，95%CI 0.47至0.96；p = 0.027）。然而，各试验间存在中度异质性（I² = 48%；p = 0.008）。亚组分析表明，与等渗对比剂相比，在使用低渗对比剂的研究中，碳酸氢钠的效果更好（OR 0.59，95%CI 0.37至0.93；p = 0.024）（等渗对比剂组OR 0.76，95%CI 0.43至1.34；p = 0.351）。在仅纳入急诊患者的研究中，使用碳酸氢钠发生CIN的几率低于择期手术患者（OR 0.16，95%CI 0.05至0.51；p = 0.002）（择期手术组OR 0.76，95%CI 0.54至1.06；p = 0.105）。与持续输注相比，在手术前给予大剂量注射的患者中，碳酸氢钠更有益（OR 0.15，95%CI 0.04至0.54；p = 0.004）（持续输注组OR 0.75，95%CI 0.53至1.05；p = 0.091）。碳酸氢钠加N - 乙酰半胱氨酸（OR 0.17，95%CI 0.04至0.79；p = 0.024）优于单独使用碳酸氢钠（OR 0.71，95%CI 0.48至1.03；p = 0.071）。与2008年后发表的论文相比，2008年前发表的论文中碳酸氢钠的效果被认为更大（OR 0.19，95%CI 0.09至0.41；p = 0.000）（2008年后发表的论文中OR 0.85，95%CI 0.62至1.16；p = 0.302）。然而，在死亡率（OR 0.69，95%CI 0.36至1.32；p = 0.263）或透析需求（OR 1.08，95%CI 0.52至2.25；p = 0.841）方面未发现显著差异。
结论
碳酸氢钠对已有肾功能不全的患者预防CIN有效。然而，它未能降低透析风险和死亡率，因此不能改善CIN患者的临床预后。
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