Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia.
Turk Kardiyol Dern Ars. 2021 Jan;49(1):51-59. doi: 10.5543/tkda.2020.14568.
The aim of this meta-analysis was to synthesize the latest evidence on the effect of probucol on the incidence of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CAG)/percutaneous coronary intervention (PCI).
A systematic literature search of PubMed, ScienceDirect, EuropePMC, ProQuest, and Clinicaltrials. gov was performed to retrieve studies that assessed probucol and CIN in CAG/PCI.
Four studies that compared probucol with hydration alone, comprising 1270 subjects, were identified and analyzed. There was no significant difference between probucol and control groups in the baseline level of creatinine and at 48 hours; however, a significant difference was observed at 72 hours (mean difference: -3.87 μmol/L; 95% confidence interval [CI]: -6.58, -1.15; p=0.005). The meta-analysis indicated that probucol did not reduce the CIN incidence (odds ratio [OR]: 0.46; 95% CI: 0.20, 1.08; p=0.08). After performing a leave-one-out sensitivity analysis, removal of a study resulted in a lower risk of CIN (OR: 0.33; 95% CI: 0.19, 0.56; p<0.001). Probucol did not reduce the CIN incidence in a pooled adjusted effect estimate (OR: 0.75; 95% CI: 0.15, 3.87; p=0.73). There was no significant difference in the rate of major adverse events between the 2 groups (OR: 0.39; 95% CI: 0.05, 3.05; p=0.37). Funnel plot results were asymmetrical, indicating possible publication bias. Grading of Recommendations, Assessment, Development and Evaluations qualification demonstrated a low and very low certainty of evidence in unadjusted and adjusted effect estimates, respectively.
Probucol did not reduce the incidence of CIN; however, due to the low certainty of evidence, further study is required for a definite conclusion. Although the p value was not significant, the confidence interval showed a nonsignificant trend toward benefit. However, this trend might have been due to publication bias.
本荟萃分析旨在综合最新证据，评估普罗布考对行冠状动脉造影（CAG）/经皮冠状动脉介入治疗（PCI）患者对比剂诱导肾病（CIN）发生率的影响。
系统检索 PubMed、ScienceDirect、EuropePMC、ProQuest 和 Clinicaltrials.gov，以获取评估 CAG/PCI 中普罗布考与 CIN 的研究。
纳入 4 项比较普罗布考与单纯水化的研究，共 1270 例患者。两组患者的基线肌酐水平和 48 小时时无显著差异，但 72 小时时存在显著差异（平均差值：-3.87 μmol/L；95%置信区间 [CI]：-6.58，-1.15；p=0.005）。荟萃分析表明，普罗布考并未降低 CIN 发生率（比值比 [OR]：0.46；95% CI：0.20，1.08；p=0.08）。进行逐一剔除敏感性分析后，剔除一项研究可降低 CIN 风险（OR：0.33；95% CI：0.19，0.56；p<0.001）。合并调整后效应估计值中，普罗布考并未降低 CIN 发生率（OR：0.75；95% CI：0.15，3.87；p=0.73）。两组间主要不良事件发生率无显著差异（OR：0.39；95% CI：0.05，3.05；p=0.37）。漏斗图结果不对称，提示可能存在发表偏倚。推荐、评估、制定与评价分级显示，在未调整和调整后效应估计中，证据确定性分别为低和极低。
普罗布考并未降低 CIN 发生率；但由于证据确定性较低，还需要进一步研究以得出明确结论。尽管 p 值无统计学意义，但置信区间显示出获益的非显著趋势。然而，这种趋势可能是由于发表偏倚所致。
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