曲美他嗪可降低肾功能不全患者行冠状动脉造影及经皮冠状动脉介入治疗后对比剂肾病的发生：系统评价与荟萃分析（PRISMA 法）。

Trimetazidine reduces contrast-induced nephropathy in patients with renal insufficiency undergoing coronary angiography and angioplasty: A systematic review and meta-analysis (PRISMA).

机构信息

Department of Radiology, Yale New Haven, Bridgeport Hospital, Connecticut.

Department of Medicine, Jersey Shore University Medical Center, Perth Amboy Divisions, New Jersey.

出版信息

Medicine (Baltimore). 2021 Mar 12;100(10):e24603. doi: 10.1097/MD.0000000000024603.

DOI:10.1097/MD.0000000000024603

PMID:33725824

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7969219/

Abstract

OBJECTIVES

This systematic review and meta-analysis assesses the utility of trimetazidine (TMZ) to prevent contrast induced nephropathy (CIN) in patients with renal insufficiency undergoing coronary angiography and angioplasty.

MATERIALS AND METHODS

This meta-analysis was formulated and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of databases was conducted by 2 researchers independently for clinical trials, comparing hydration plus TMZ vs conventional hydration alone for prevention of CIN through January 2020. All patients had renal insufficiency (defined as GFR < 89 ml/minute/1.73 m2) and the outcome of interest was the incidence of contrast induced acute kidney injury. The odds ratio (OR) was estimated with 95% confidence interval (CI). Heterogeneity was reported with the I2 statistic, using a fixed-effects model, and >50% of I2 was considered to be statistically significant.

RESULTS

Eleven studies, 1611 patients, met the inclusion/exclusion criteria: 797 patients comprised the TMZ plus hydration group and the remaining 814 patients comprised the control (hydration only) group. Heterogeneity was low I2 = 0%, P = .84, and the heterogeneity of each study was also low. The incidence of CIN in the TMZ plus hydration group was 6.6% (53/797), while the incidence of CIN in the control (hydration only) group was 20% (165/814). Pooled analysis of all studies showed TMZ reduced incidence of CIN compared to saline hydration alone (OR risk 0.30, 95% CI 0.21, 0.42, P < .0001).

CONCLUSION

TMZ added to hydration reduces CIN in renal insufficiency patients undergoing coronary angiography.

摘要

目的

本系统评价和荟萃分析评估了曲美他嗪（TMZ）在接受冠状动脉造影和血管成形术的肾功能不全患者中预防对比剂诱导肾病（CIN）的效用。

材料和方法

本荟萃分析根据系统评价和荟萃分析的首选报告项目（PRISMA）指南制定和报告。两名研究人员独立对数据库进行了搜索，以查找比较水化加 TMZ 与单独常规水化预防 CIN 的临床试验，检索时间截至 2020 年 1 月。所有患者均有肾功能不全（定义为肾小球滤过率 < 89 ml/min/1.73 m2），研究的主要转归为对比剂诱导的急性肾损伤的发生率。使用固定效应模型估计比值比（OR）及其 95%置信区间（CI）。使用 I2 统计量报告异质性，I2 > 50%被认为具有统计学意义。

结果

符合纳入/排除标准的 11 项研究共纳入 1611 例患者：TMZ 加水化组 797 例，对照组（仅水化）814 例。异质性低（I2 = 0%，P =.84），且各研究的异质性也较低。TMZ 加水化组的 CIN 发生率为 6.6%（53/797），对照组（仅水化）的 CIN 发生率为 20%（165/814）。所有研究的汇总分析表明，与单独生理盐水水化相比，TMZ 降低了 CIN 的发生率（OR 风险 0.30，95% CI 0.21，0.42，P <.0001）。