碳酸氢钠预防对比剂肾病疗效的Meta分析  

The Efficacy of Sodium Bicarbonate Preventing Contrast-Induced Nephropathy:a Meta-Analysis of Randomized Controlled Trials

作　　者：张斌[1,2] 梁龙[1,2] 陈文波[2] 郑君惠[2] 李新云[2] 梁长虹[2] 张水兴[2] 

机构地区：[1]南方医科大学研究生学院,广州510515 [2]广东省人民医院/广东省医学科学院放射科,广州510080

出　　处：《临床放射学杂志》2015年第7期1152-1158,共7页Journal of Clinical Radiology

基　　金：国家自然科学基金面上项目(编号:81171329);广东省自然科学基金面上项目(编号:S2011010000790)

摘　　要：目的探讨碳酸氢钠预防对比剂肾病（CIN）的疗效,进一步评估碳酸氢钠是否能够降低肾替代治疗和死亡的风险。方法检索Pub Med、Medline、Cochrane library数据库,同时辅以手工检索等,搜集碳酸氢钠预防CIN的相关文献。按照纳入、排除标准筛选文献,参考修订后的Jadad量表进行质量评价,提取有效数据,采用Rev Man 5.3软件进行统计学分析。结果共有24个随机对照试验（RCT）,5295例患者纳入研究。Meta分析结果显示,碳酸氢钠组CIN的发生率显著低于氯化钠组[优势比（OR）=0.59,95%可信区间（CI）：0.43~0.82,P=0.001]。然而两组在肾替代治疗发生率以及死亡率方面的差异无统计学意义（P〉0.05）。亚组分析结果显示,相较于等渗对比剂（OR=0.65,95%CI：0.37~1.15,P=0.14）,使用低渗对比剂（OR=0.50,95%CI：0.32~0.79,P=0.003）时碳酸氢钠保护肾脏、预防CIN发生的疗效更明显。和择期检查（OR=0.67,95%CI：0.48~0.94,P=0.02）相比,急诊检查（OR=0.13,95%CI：0.05~0.35,P〈0.0001）使用碳酸氢钠,其预防作用更明显。肾功能正常（OR=0.36,95%CI：0.17~0.76,P=0.007）和肾功能不全的患者（OR=0.67,95%CI：0.47~0.96,P=0.03）相比,前者碳酸氢钠预防效果更为明显。联合使用N-乙酰半胱氨酸（OR=0.23,95%CI：0.12~0.46,P〈0.0001）比单独使用碳酸氢钠（OR=0.69,95%CI：0.51~0.94,P=0.02）更有优势。全程持续输注结合造影前短时间内团注碳酸氢钠溶液（OR=0.15,95%CI：0.04~0.54,P=0.004）比单纯全程持续输注（OR=0.64,95%CI：0.47~0.88,P=0.005）更有效。结论碳酸氢钠可有效预防CIN的发生,其疗效一定程度上受对比剂类型、输注方式、患者肾功能状况等因素的影响。预防应用碳酸氢钠不能降低肾替代治疗和死亡的风险,不能改善CIN患者的临床预后。Objective The aims of this study were to explore the efficacy of sodium bicarbonate in preventing contrastinduced nephropathy（CIN） and assess if sodium bicarbonate could reduce the risks of renal replacement therapy and mortality,thus improving the clinical prognosis of patients with CIN.Methods All relevant articles were obtained from databases including Pub Med,Medline,Cochrane library.Dates were also searched by manual retrieval.We Selected papers according to inclusion and exclusion criteria.The quality of literatures in this study was evaluated using a new Jadad scale after revision and data analyzed by Rev Man software（version 5.3）.Results A total of 24 RCTs consisting of 5,295 patients were included in this study.This updated Meta analysis suggested that sodium bicarbonate was associated with a significant decrease in the rate of CIN（OR = 0.59,95% CI：0.43-0.82,P = 0.001）.However,no significant differences were found in the renal replacement therapy and mortality（P〈0.05）.Subgroup analyses indicated a more pronounced effect of sodium bicarbonate in studies using low-osmolar contrast agents（OR = 0.50,95% CI：0.32-0.79,P = 0.003）compared with those using iso-osmolar ones（OR = 0.65,95% CI：0.37-1.15,P = 0.14）.Similarly,a lower odds of CIN with sodium bicarbonate occurred in studies including exclusively patients undergoing emergency procedures（OR = 0.13,95% CI：0.05-0.35,P〈0.0001） compared with those undergoing elective ones（OR = 0.67,95% CI：0.48-0.94,P= 0.02）.Furthermore,sodium bicarbonate played a more active role in patients given a bolus injection before procedures（OR = 0.15,95% CI：0.04-0.54,P = 0.004） compared with continuous infusion（OR = 0.64,95% CI：0.47-0.88,P = 0.005）.Sodium bicarbonate in combination with N-acetylcysteine（NAC）（OR = 0.23,95% CI：0.12-0.46,P〈0.0001） outweighed sodium bicarbonate alone（OR = 0.69,95% CI：0.51-0.94,P = 0.02） Conclusion The infusion of sodium bicarbonate can significantly reduce the incidence of CIN,and

关 键 词：碳酸氢钠 氯化钠 对比剂肾病 META分析 

分 类 号：R692[医药卫生—泌尿科学]