他汀类药物对慢性肾脏病患者肾脏结局的影响：一项系统评价与Meta分析
Effects of Statins on Renal Outcome in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis.
作者信息
Sanguankeo Anawin, Upala Sikarin, Cheungpasitporn Wisit, Ungprasert Patompong, Knight Eric L
机构信息
Department of Internal Medicine, Columbia University College of Physicians and Surgeons, Bassett Medical Center, Cooperstown, New York, United States of America; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America.
Department of Internal Medicine, Columbia University College of Physicians and Surgeons, Bassett Medical Center, Cooperstown, New York, United States of America; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
出版信息
PLoS One. 2015 Jul 7;10(7):e0132970. doi: 10.1371/journal.pone.0132970. eCollection 2015.
BACKGROUND
HMG CoA reductase inhibitors (statins) are known to prevent cardiovascular disease and improve lipid profiles. However, the effects of statins on renal outcomes, including decline in estimated glomerular filtration rate (eGFR) and proteinuria in patients with chronic kidney disease (CKD), are controversial. This meta-analysis evaluated the impact of statins on renal outcomes in patients with CKD.
MATERIALS AND METHODS
We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane Databases. The inclusion criteria were published RCT and cohort studies comparing statin therapy to placebo or active controls in patients with CKD (eGFR <60 ml/min/1.73 m(2)) not requiring dialysis. The primary outcome was the differences in the change of eGFR. We also examined change of protein concentration in urine as a secondary outcome. A meta-analysis comparing statin and its control groups and a subgroup analysis examining intensity of statin were performed.
RESULTS
From 142 full-text articles, 10 studies were included in the meta-analysis. Overall, there was a significant difference in rate of eGFR change per year favoring statin group (mean difference (MD) = 0.10 ml/min/1.73 m(2), 95% CI: 0.09 to 0.12). In our subgroup analysis, those who received high-intensity statins had a significant difference in eGFR with a MD of 3.35 (95% CI: 0.91 to 5.79) ml/min/1.73 m(2) compared to control. No significant change in eGFR was found with moderate- and low-intensity statin therapy. Compared with the control group, the statin group did not have a difference in reduction of proteinuria with MD in change of proteinuria of 0.19 gm/day (95% CI: -0.02 to 0.40).
CONCLUSION
Overall, there was a difference in change of eGFR between the statin and control group. High-intensity statins were found to improve a decline in eGFR in population with CKD not requiring dialysis compared with control, but moderate- and low-intensity statins were not. Statins were not found to decrease proteinuria in patients with CKD.
背景
已知羟甲基戊二酸单酰辅酶A还原酶抑制剂（他汀类药物）可预防心血管疾病并改善血脂状况。然而，他汀类药物对肾脏结局的影响，包括慢性肾脏病（CKD）患者估算肾小球滤过率（eGFR）下降和蛋白尿，仍存在争议。本荟萃分析评估了他汀类药物对CKD患者肾脏结局的影响。
材料与方法
我们全面检索了MEDLINE、EMBASE和Cochrane数据库。纳入标准为已发表的随机对照试验（RCT）和队列研究，比较他汀类药物治疗与安慰剂或活性对照在无需透析的CKD患者（eGFR<60 ml/min/1.73 m²）中的疗效。主要结局是eGFR变化的差异。我们还将尿蛋白浓度变化作为次要结局进行了研究。进行了比较他汀类药物组与其对照组的荟萃分析以及研究他汀类药物强度的亚组分析。
结果
从142篇全文文章中，有10项研究纳入了荟萃分析。总体而言，他汀类药物组每年的eGFR变化率存在显著差异（平均差值（MD）=0.10 ml/min/1.73 m²，95%置信区间：0.09至0.12）。在我们的亚组分析中，与对照组相比，接受高强度他汀类药物治疗的患者eGFR存在显著差异，MD为3.35（95%置信区间：0.91至5.79）ml/min/1.73 m²。中低强度他汀类药物治疗未发现eGFR有显著变化。与对照组相比，他汀类药物组蛋白尿减少无差异，蛋白尿变化的MD为0.19 g/天（95%置信区间：-0.02至0.40）。
结论
总体而言，他汀类药物组与对照组在eGFR变化方面存在差异。与对照组相比，发现高强度他汀类药物可改善无需透析的CKD患者的eGFR下降，但中低强度他汀类药物则不然。未发现他汀类药物可降低CKD患者的蛋白尿。
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