他汀类药物对常染色体显性遗传性多囊肾病患者肾功能及肾脏总体积的影响。
Effect of Statins on Renal Function and Total Kidney Volume in Autosomal Dominant Polycystic Kidney Disease.
作者信息
Xue Cheng, Zhang Li-Ming, Zhou Chenchen, Mei Chang-Lin, Yu Sheng-Qiang
机构信息
Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Department of Nephrology, Zhabei Central Hospital of Jing'an District, Shanghai, China.
出版信息
Kidney Dis (Basel). 2020 Nov;6(6):407-413. doi: 10.1159/000509087. Epub 2020 Jul 29.
BACKGROUND
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary nephropathy with few treatments to slow renal progression. The evidence on the effect of lipid-lowering agents (statins) on ADPKD progression remains inconclusive.
METHODS
We performed a systematic review and meta-analysis by searching the PubMed, Embase, Web of Science, and Cochrane databases (up to November 2019). Changes in estimated glomerular filtration rate (eGFR) and total kidney volume (TKV) were the primary outcomes. Mean differences (MDs) for continuous outcomes and 95% confidence intervals (CIs) were calculated by a random-effects model.
RESULTS
Five clinical studies with 648 participants were included. Statins did not show significant benefits in the yearly change in eGFR (4 studies, MD = -0.13 mL/min/m, 95% CI: -0.78 to 0.52, = 0.70) and the yearly change in TKV (3 studies, MD = -1.17%, 95% CI: -3.40 to 1.05, = 0.30) compared with the control group. However, statins significantly decreased urinary protein excretion (-0.10 g/day, 95% CI: -0.16 to -0.03, = 0.004) and serum low-density lipoprotein level (-0.34 mmol/L, 95% CI: -0.58 to -0.10, = 0.006).
CONCLUSION
Despite these proteinuria and lipid-lowering benefits, the effect of statins on ADPKD progression was uncertain.
背景
常染色体显性遗传性多囊肾病（ADPKD）是最常见的遗传性肾病，几乎没有延缓肾脏病变进展的治疗方法。关于降脂药物（他汀类药物）对ADPKD进展影响的证据尚无定论。
方法
我们通过检索PubMed、Embase、科学网和Cochrane数据库（截至2019年11月）进行了系统评价和荟萃分析。估计肾小球滤过率（eGFR）和肾脏总体积（TKV）的变化是主要结局指标。连续性结局指标的平均差值（MDs）和95%置信区间（CIs）采用随机效应模型计算。
结果
纳入了5项临床研究，共648名参与者。与对照组相比，他汀类药物在eGFR的年变化（4项研究，MD = -0.13 mL/min/m，95% CI：-0.78至0.52，I² = 0.70）和TKV的年变化（3项研究，MD = -1.17%，95% CI：-3.40至1.05，I² = 0.30）方面未显示出显著益处。然而，他汀类药物显著降低了尿蛋白排泄量（-0.10 g/天，95% CI：-0.16至-0.03，I² = 0.004）和血清低密度脂蛋白水平（-0.34 mmol/L，95% CI：-0.58至-0.10，I² = 0.006）。
结论
尽管他汀类药物有降低蛋白尿和血脂的益处，但其对ADPKD进展的影响仍不确定。
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