Thamcharoen Natanong, Thongprayoon Charat, Edmonds Peter J, Cheungpasitporn Wisit
Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
N Am J Med Sci. 2015 Oct;7(10):446-51. doi: 10.4103/1947-2714.168670.
Nebivolol provides a protective effect on contrast-induced acute kidney injury (CIAKI) in animal models. However, the reports on the efficacy of nebivolol for the prevention of CIAKI in human remain unclear.
The objective of this meta-analysis was to assess the effect of nebivolol for the prevention of CIAKI.
Comprehensive literature searches were performed using MEDLINE, EMBASE, and Cochrane Database from inception through February 2015. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of CIAKI in patients who received nebivolol versus those who did not were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
Four studies (2 randomized controlled trials and 2 cohort studies) with 543 patients were included in our analysis to assess the risk of CIAKI and the use of nebivolol. Patients in the nebivolol group had an overall lower incidence of CIAKI (14.4%) compared to the control group (18.4%). The pooled RR of CIAKI in patients receiving nebivolol was 0.66 (95% CI: 0.38-1.15, I (2) = 0). When meta-analysis was limited only to randomized control trials (RCTs), the pooled RR of CIAKI in patients receiving nebivolol was 0.79 (95% CI: 0.35-1.79, I (2) = 0%).
Despite no statistical significance, there was a trend toward reduced CIAKI risk in patients receiving nebivolol. The findings of our meta-analysis suggest the need of a large RCT with very careful attention to the balance of benefits and harms.
在动物模型中，奈必洛尔对造影剂诱导的急性肾损伤（CIAKI）具有保护作用。然而，关于奈必洛尔预防人类CIAKI疗效的报道仍不明确。
本荟萃分析的目的是评估奈必洛尔预防CIAKI的效果。
使用MEDLINE、EMBASE和Cochrane数据库进行全面的文献检索，检索时间从数据库建立至2015年2月。纳入报告了接受奈必洛尔治疗的患者与未接受奈必洛尔治疗的患者发生CIAKI风险的相对风险、比值比或风险比的研究。采用随机效应、通用逆方差法计算合并风险比（RR）和95%置信区间（CI）。
我们的分析纳入了4项研究（2项随机对照试验和2项队列研究），共543例患者，以评估CIAKI风险和奈必洛尔的使用情况。与对照组（18.4%）相比，奈必洛尔组患者CIAKI的总体发生率较低（14.4%）。接受奈必洛尔治疗的患者发生CIAKI的合并RR为0.66（95%CI：0.38 - 1.15，I² = 0）。当荟萃分析仅限于随机对照试验（RCT）时，接受奈必洛尔治疗的患者发生CIAKI的合并RR为0.79（95%CI：0.35 - 1.79，I² = 0%）。
尽管无统计学意义，但接受奈必洛尔治疗的患者CIAKI风险有降低趋势。我们荟萃分析的结果表明需要进行一项大型RCT，并非常仔细地关注利弊平衡。
