Department of Pharmacy, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.
Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Medicine (Baltimore). 2023 Mar 17;102(11):e33273. doi: 10.1097/MD.0000000000033273.
Preventing contrast-induced acute kidney injury (CI-AKI) is critical because of its association with poor clinical outcomes, including extended hospital stays and increased mortality. The effects of probucol on preventing CI-AKI have been controversial. Therefore, this systematic review and meta-analysis evaluated the influence of probucol combined with hydration on the CI-AKI risk in patients with coronary heart disease undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).
We retrieved data from the following databases from their inception to May 29, 2022: PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database (Sinomed), Wanfang Database, and Chinese Scientific Journal Database. The methodological quality of the trials was assessed following the Cochrane Handbook guidelines, and Review Manager 5.3 and Stata 14.0 software were used for the data analysis.
We included 14 trials comprising 3306 patients in the analysis. All included trials reported the CI-AKI incidence rate (the primary outcome). Probucol with hydration significantly reduced the CI-AKI incidence compared to hydration alone (odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.25-0.44, P < .001). Subgroup analyses were performed based on the contrast medium type (iso-osmolality vs low-osmolality contrast medium [LOCM]) and volume (less than or more than 200 mL); the effects of probucol with hydration versus hydration-only on CI-AKI were comparable within each subgroup. Additionally, the serum creatinine (Scr) concentration 24 hours, 48 hours, and 72 hours and the estimated glomerular filtration rate (eGFR) 72 hours after contrast exposure were better in the probucol with hydration group than the hydration-only group. Finally, major clinical adverse events and adverse drug reactions were comparable between the probucol with hydration and hydration-only groups.
Probucol with hydration decreases the CI-AKI incidence compared to hydration only in patients with coronary heart disease undergoing CAG or PCI. However, more high-quality, large-sample, multicenter randomized trials are needed to confirm this conclusion.
由于 contrast-induced acute kidney injury（CI-AKI）与较差的临床结局相关，包括延长住院时间和增加死亡率，因此预防其发生至关重要。普罗布考预防 CI-AKI 的效果存在争议。因此，本系统评价和荟萃分析评估了普罗布考联合水化对行冠状动脉造影（CAG）或经皮冠状动脉介入治疗（PCI）的冠心病患者 CI-AKI 风险的影响。
我们从以下数据库中检索了从成立到 2022 年 5 月 29 日的数据：PubMed、Embase、Web of Science、Cochrane Library、中国国家知识基础设施（CNKI）、中国生物医学文献数据库（Sinomed）、万方数据库和中国科学期刊数据库。根据 Cochrane 手册指南评估试验的方法学质量，并使用 Review Manager 5.3 和 Stata 14.0 软件进行数据分析。
我们纳入了 14 项试验，共 3306 例患者。所有纳入的试验均报告了 CI-AKI 发生率（主要结局）。与单独水化相比，普罗布考联合水化可显著降低 CI-AKI 发生率（比值比 [OR]：0.33，95%置信区间 [CI]：0.25-0.44，P<0.001）。根据造影剂类型（等渗性与低渗性造影剂 [LOCM]）和容量（<200 毫升或≥200 毫升）进行了亚组分析；在每个亚组内，普罗布考联合水化与单独水化对 CI-AKI 的影响相当。此外，造影后 24 小时、48 小时和 72 小时的血清肌酐（Scr）浓度和 72 小时的估算肾小球滤过率（eGFR）在普罗布考联合水化组优于单独水化组。最后，普罗布考联合水化组与单独水化组的主要临床不良事件和药物不良反应相当。
与单独水化相比，普罗布考联合水化可降低行 CAG 或 PCI 的冠心病患者的 CI-AKI 发生率。然而，需要更多高质量、大样本、多中心的随机试验来证实这一结论。
