碳酸镧对血液透析患者冠状动脉钙化进展的影响：一项随机对照试验的荟萃分析。
Effect of lanthanum carbonate on the progression of coronary artery calcification in hemodialysis patients: A meta-analysis of randomized controlled trials.
机构信息
The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
出版信息
Hemodial Int. 2022 Apr;26(2):223-233. doi: 10.1111/hdi.12988. Epub 2021 Dec 13.
INTRODUCTION
Coronary artery calcification and cardiac abnormalities are common in hemodialysis patients. The value of lanthanum carbonate over calcium-based phosphate binders in managing the progression of coronary artery calcification is debated. We reviewed all randomized controlled trials (RCTs) comparing the two strategies in these patients.
METHODS
RCTs comparing lanthanum carbonate with calcium-based phosphate binders used in adult hemodialysis patients were identified in the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal, and Wanfang databases.
FINDINGS
Ten RCTs involving 687 patients were suitable for inclusion. Compared with calcium-based phosphate binders, lanthanum carbonate yielded lower coronary artery calcium scores (weighted mean difference, WMD: -74.28, 95% CI: -149.89, 1.33), change in coronary artery calcium scores (WMD: -105.18, 95% CI: -113.83, -96.53), and left ventricular mass index (WMD: -29.95, 95% CI: -54.25, -7.45). Lanthanum carbonate was significantly associated with lower levels of serum phosphate (WMD: -0.18, 95% CI: -0.26, -0.10), calcium (WMD: -0.22, 95% CI: -0.25, -0.20), and fibroblast growth factor 23 (FGF23) (standard mean difference: -3.78, 95% CI: -5.60, -1.96) but not intact parathyroid hormone (WMD: -4.23, 95% CI: -64.12, 55.65). Moreover, a reduced risk of nonfatal cardiovascular events (OR: 0.31, 95% CI: 0.10-0.97) but not all-cause mortality (OR: 1.08, 95% CI: 0.39-3.01) in lanthanum carbonate therapy was observed.
DISCUSSION
In hemodialysis patients, lanthanum carbonate therapy may impede the progression of coronary artery calcification and left ventricular mass index and lead to reduced serum phosphate, calcium, FGF23, and nonfatal cardiovascular events compared with calcium-based phosphate binders. However, more well-designed RCTs are required for confirmation.
简介
在血液透析患者中，冠状动脉钙化和心脏异常很常见。在控制冠状动脉钙化进展方面，碳酸镧相对于钙基磷酸盐结合剂的价值存在争议。我们回顾了所有比较这两种策略在这些患者中的随机对照试验（RCT）。
方法
在 PubMed、EMBASE、Cochrane 图书馆、中国知网、中国科技期刊和万方数据库中确定了比较碳酸镧与钙基磷酸盐结合剂在成年血液透析患者中使用的 RCTs。
结果
纳入了 10 项涉及 687 名患者的 RCT。与钙基磷酸盐结合剂相比，碳酸镧可降低冠状动脉钙分数（加权均数差，WMD：-74.28，95%CI：-149.89，1.33）、冠状动脉钙分数变化（WMD：-105.18，95%CI：-113.83，-96.53）和左心室质量指数（WMD：-29.95，95%CI：-54.25，-7.45）。碳酸镧与较低的血清磷酸盐水平（WMD：-0.18，95%CI：-0.26，-0.10）、钙（WMD：-0.22，95%CI：-0.25，-0.20）和成纤维细胞生长因子 23（FGF23）（标准均数差：-3.78，95%CI：-5.60，-1.96）显著相关，但与完整甲状旁腺激素（WMD：-4.23，95%CI：-64.12，55.65）无关。此外，在碳酸镧治疗中，非致命性心血管事件的风险降低（OR：0.31，95%CI：0.10-0.97），而非全因死亡率（OR：1.08，95%CI：0.39-3.01）无显著差异。
讨论
在血液透析患者中，与钙基磷酸盐结合剂相比，碳酸镧治疗可能会阻止冠状动脉钙化和左心室质量指数的进展，并导致血清磷酸盐、钙、FGF23 和非致命性心血管事件减少。然而，还需要更多设计良好的 RCT 来证实。
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