盐酸司维拉姆对维持性血液透析患者心血管钙化影响的荟萃分析  

Meta-analysis of the effect of sevelamer hydrochloride on cardiovascular calcification in maintenance hemodialysis patients

作　　者：张倩[1] 李明[2] 陈靖[1] 

机构地区：[1]复旦大学附属华山医院肾脏科复旦大学肾脏病研究所,上海200040 [2]复旦大学附属华山医院内科,上海200040

出　　处：《中华肾脏病杂志》2009年第10期739-744,共6页Chinese Journal of Nephrology

基　　金：教育部新世纪优秀人才支持计划

摘　　要：目的评价盐酸司维拉姆（sevelamer hydrochloride，盐酸聚丙烯胺，Renagel）和含钙的磷结合剂对维持性血液透析（MHD）患者心血管钙化的影响。方法在Medline、CENTRAL和中国生物医学文献数据库中检索国内外已发表和未发表的相关文献，选择针对MHD患者、使用盐酸司维拉姆和含钙的磷结合剂两种药物进行比较的随机对照临床试验。两位评价者分别按检索策略收集资料，根据入选标准和排除标准筛选文献，对符合标准的文献进行荟萃分析。结果共有5篇文献（697例）符合入选标准。与使用钙磷结合剂的患者比较，使用盐酸司维拉姆的患者冠状动脉钙化积分较低，合并加权均数差（WMD）=-66．84，95％可信区间（CI）为0126．90～-6．77；主动脉的钙化积分较低，合并WMD=-140．26，95％CI为-224．04～-56．47；住院率较低，合并相对危险度（RR）为0．75（95％CI：0．59～0．95，P=0．02）；而病死率在两组药物使用者间差异无统计学意义，合并RR为0．76（95％CI：0．37～1．57，P=0．45）。结论与钙磷结合剂比较，盐酸司维拉姆可以明显改善MHD患者的心血管钙化程度，进而降低患者的住院率。Objective To evaluate the effect of sevelamer hydrochloride on parameters of coronary artery calcification （CAC）, mineral metabolism and lipid profile in maintenance hemodialysis （MHD） patients. Methods Medline, CENTRAL and Chinese biomedical database were retrieved by using the key words ＂sevelamer or Renagel＂ so as to search the materials about the randomized controlled clinical trials that had compared the effects of sevelamer and calcium- based phosphate binders （CBPB） on cardiovascular calcification in MHD patients. A recta-analysis was conducted. Results Five documents about randomized controlled clinical trials, including 697 patients, from the retrieved 276 documents according to the demand of enrollment. Compared with CBPB, there was a significantly lower coronary artery calcification score in MHD patients treated with sevelamer （weighted mean difference -66.84, 95%CI -126.90 to -6.77）. The funnel plot test regarding CAC score did not indicate the existence of publication bias. The multiple mortality of sevelamer group was 4.2%, not significantly different from that of CBPB group 5.6% （RR=0.76, 95%CI 0.37 to 1.57, P=0.45）. However, the hospitalization rate of sevelamer group was lower （RR=0.75, 95%CI 0.59 to 0.95, P=0.02）. Sensitive analysis confirmed the nonexistence of differences in CAC score and hospitalization rate between these two groups. Conclusions Sevelamer improves the CAC score of MHD patients compared with CBPB. Treatment with sevelamer does not affect overall mortality, but there is evidence for beneficial effect on multiple all-cause hospitalizations.

关 键 词：冠状血管 钙质沉着症 血液透析 盐酸司维拉姆 荟萃分析 

分 类 号：R459.5[医药卫生—治疗学] R692.5[医药卫生—临床医学]