经皮冠状动脉介入治疗患者中使用前列腺素E1预防造影剂肾病：24项随机对照试验的荟萃分析

Prevention of contrast-induced nephropathy with prostaglandin E1 in patients undergoing percutaneous coronary procedures: A meta-analysis of 24 randomized controlled trials .

作者信息

Liu Xiangying, Hang Yongfu, Shen Lei, Yang Jing, Zhou Ling, Sha Wengang, Lu Guoyuan

出版信息

Clin Nephrol. 2018 Nov;90(5):313-324. doi: 10.5414/CN109444.

DOI:10.5414/CN109444

PMID:30106366

Abstract

BACKGROUND

Contrast-induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients. There have been many conflicting results across trials that have evaluated the prophylactic efficacy of prostaglandin E1 (PGE1) for prevention of CIN in patients undergoing percutaneous coronary procedures. PGE1 may have renal-protective effects due to its pleiotropic properties. The aim of this study was to evaluate the efficacy of PGE1 in preventing CIN.

MATERIALS AND METHODS

We searched PubMed, Embase, Cochrane Library, Chinese Biomedical Literature, China National Knowledge Infrastructure, VIP Information/Chinese Scientific Journals, and WANFANG databases for randomized controlled trials (RCTs) comparing the preventive effects of PGE1 versus controls (conventional hydration, no PGE1, or placebo) on CIN in patients undergoing percutaneous coronary procedures from January 1999 to June 2016. Study characteristics and outcome data were abstracted by two independent reviewers; the risk of bias was also assessed by two reviewers.

RESULTS

24 RCTs involving 3,915 patients were included. Compared with controls, PGE1 reduced the risk of CIN (risk ratio: 0.40, 95% confidence interval (CI): 0.33, 0.48; p < 0.01). Serum creatinine levels in the PGE1 groups were significantly lower than in the control groups at 24, 48, and 72 hours after operation (mean difference (MD): -10.06, 95% CI: -16.94, -3.19; MD: -15.47, 95% CI: -21.75, -9.18; and MD: -11.15, 95% CI: -14.40, -7.91, respectively). Cystatin C was significantly lower for the PGE1 group than the control groups at 24, 48, and 72 hours after operation (MD: -0.24, 95% CI: -0.40, -0.07; MD: -0.34, 95% CI: -0.53, -0.14; and MD: -0.32, 95% CI: -0.49, -0.15, respectively).

CONCLUSION: PGE1 may play an important role in reducing the incidence of CIN in patients undergoing percutaneous coronary procedures. .

摘要

背景

对比剂肾病（CIN）是住院患者急性肾损伤的第三大常见病因。在评估前列腺素E1（PGE1）对接受经皮冠状动脉介入治疗患者预防CIN的预防效果的试验中，存在许多相互矛盾的结果。PGE1因其多效性可能具有肾脏保护作用。本研究的目的是评估PGE1预防CIN的效果。

材料与方法

我们检索了PubMed、Embase、Cochrane图书馆、中国生物医学文献数据库、中国知网、维普资讯/中文科技期刊数据库和万方数据库，以查找1999年1月至2016年6月期间比较PGE1与对照组（常规水化、无PGE1或安慰剂）对接受经皮冠状动脉介入治疗患者CIN预防效果的随机对照试验（RCT）。研究特征和结局数据由两名独立的评审员提取；偏倚风险也由两名评审员评估。

结果

纳入了24项涉及3915例患者的RCT。与对照组相比，PGE1降低了CIN的风险（风险比：0.40，95%置信区间（CI）：0.33，0.48；p<0.01）。术后24、48和72小时，PGE1组的血清肌酐水平显著低于对照组（平均差值（MD）：-10.06，95%CI：-16.94，-3.19；MD：-15.47，95%CI：-21.75，-9.18；MD：-11.15，95%CI：-14.40，-7.91）。术后24、48和72小时，PGE1组的胱抑素C显著低于对照组（MD：-0.24，95%CI：-0.40，-0.07；MD：-0.34，95%CI：-0.53，-0.14；MD：-0.32，95%CI：-0.49，-0.15）。