Zhang Guo-Qiang, Chen Jin-Liang, Zhao Yong
No. 3 Office of Student Affairs, Chongqing Medical University, Chongqing, China.
Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Pediatr Nephrol. 2016 Mar;31(3):373-9. doi: 10.1007/s00467-015-3098-2. Epub 2015 May 19.
Renal scarring after acute pyelonephritis (APN) in children is of concern and in the worst cases leads to long-term cardiovascular morbidity. There are reports that vitamin A may alleviate renal damage following APN. We conducted a meta-analysis to investigate the role of vitamin A in the alleviation of renal damage.
We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials (CENTRAL, the Cochrane Library) and the Wang Fang database (Chinese) from their inception to February 3, 2015 for randomized controlled trials (RCTs) investigating vitamin A and renal damage. Primary outcome was number of patients/kidneys with renal damage, defined as persistence of photopenic lesions based on technetium-99m dimercaptosuccinic acid renal scintigraphy. We calculated pooled relative risks for renal damage in the vitamin A group.
Four RCTs, involving a total of 248 patients aged 1-144 months (120 in experimental group, 128 in control group), were included in the meta-analysis. Vitamin A was inversely associated with renal damage (relative risk 0.53, 95 % confidence interval 0.43, 0.67) when compared with placebo group after an average follow-up of 5 months.
Current evidence indicates that vitamin A may exert a preventive effect on renal damage in children with APN. However, this finding largely relies on a few studies of low methodological quality, i.e., high risk of selection bias, performance bias and attrition bias. Hence, high-quality and adequately powered RCTs are warranted.
儿童急性肾盂肾炎（APN）后的肾瘢痕形成令人担忧，在最严重的情况下会导致长期心血管疾病。有报道称，维生素A可能减轻APN后的肾损伤。我们进行了一项荟萃分析，以研究维生素A在减轻肾损伤中的作用。
我们检索了PubMed、EMBASE、Cochrane对照试验中央注册库（CENTRAL，Cochrane图书馆）和万方数据库（中文），检索时间从各数据库建库至2015年2月3日，以查找研究维生素A与肾损伤的随机对照试验（RCT）。主要结局是发生肾损伤的患者/肾脏数量，肾损伤定义为基于锝-99m二巯基丁二酸肾闪烁显像的放射性缺损灶持续存在。我们计算了维生素A组肾损伤的合并相对风险。
四项RCT纳入了荟萃分析，共涉及248例年龄在1至144个月的患者（试验组120例，对照组128例）。平均随访5个月后，与安慰剂组相比，维生素A与肾损伤呈负相关（相对风险0.53，95%置信区间0.43，0.67）。
目前的证据表明，维生素A可能对APN患儿的肾损伤具有预防作用。然而，这一发现很大程度上依赖于少数方法学质量较低的研究，即存在较高的选择偏倚、执行偏倚和失访偏倚风险。因此，需要高质量且有足够样本量的RCT。
