Ali-Hasan-Al-Saegh Sadeq, Ali-Hassan-Sayegh Sadegh, Mirhosseini Seyed Jalil, Rahimizadeh Elham, Ghodratipour Zahra, Sarrafan-Chaharsoughi Zahra, Dehghan Ali Mohammad, Lotfaliani Mohammad Reza, Rezaeisadrabadi Mohammad, Kayvanpour Elham, Sedaghat-Hamedani Farbod, Zeriouh Mohamed, Weymann Alexander, Sabashnikov Anton, Popov Aron-Frederik
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Department of Medicine III, University of Heidelberg, Heidelberg, Germany.
Cardiol Res Pract. 2015;2015:690308. doi: 10.1155/2015/690308. Epub 2015 Apr 21.
This systematic review with meta-analysis sought to determine comparison of efficacy and safety of hydration with sodium bicarbonate versus sodium chloride on contrast induced nephropathy and clinical outcomes. We searched major electronic databases for studies in randomized controlled trials. A value of P < 0.1 for Q test or I (2) > 50% indicated significant heterogeneity between the studies. Literature search of all databases retrieved 650 studies. 29 studies enrolled in meta-analysis. Pooled analysis indicated about the incidence of CIN (OR of 0.718; 95% CI: 0.60 to 0.85; P = 0.000), requirement of hemodialysis (OR of 1.00; 95% CI: 0.49 to 2.01; P = 0.9), mean changes of serum creatinine (WMD of 2.321; 95% CI: 1.995 to 2.648; P = 0.000), length of hospital stays (WMD of -0.774; 95% CI: -1.65 to 0.10; P = 0.08), major adverse cardiovascular events (OR = 1.075, 95% CI: 0.59 to 1.95; P = 0.8), and mortality (OR of 0.73; 95% CI: 0.42 to 1.26; P = 0.2). Overall, hydration with sodium bicarbonate could significantly reduce CIN and the length of hospital stay compared to sodium chloride. In addition NAC added as a supplement to sodium bicarbonate could increase prophylactic effects against nephropathy.
这项荟萃分析的系统评价旨在确定碳酸氢钠与氯化钠水化疗法在对比剂肾病及临床结局方面的疗效和安全性比较。我们检索了主要电子数据库以查找随机对照试验的研究。Q检验P值<0.1或I²>50%表明研究间存在显著异质性。对所有数据库的文献检索共获得650项研究。29项研究纳入荟萃分析。汇总分析显示了对比剂肾病的发生率（比值比为0.718；95%置信区间：0.60至0.85；P = 0.000）、血液透析需求（比值比为1.00；95%置信区间：0.49至2.01；P = 0.9）、血清肌酐的平均变化（加权均数差为2.321；95%置信区间：1.995至2.648；P = 0.000）、住院时间（加权均数差为-0.774；95%置信区间：-1.65至0.10；P = 0.08）、主要不良心血管事件（比值比 = 1.075，95%置信区间：0.59至1.95；P = 0.8）和死亡率（比值比为0.73；95%置信区间：0.42至1.26；P = 0.2）。总体而言，与氯化钠相比，碳酸氢钠水化疗法可显著降低对比剂肾病的发生率和住院时间。此外，作为碳酸氢钠补充剂添加的N-乙酰半胱氨酸可增强对肾病的预防作用。
