前列地尔防治冠心病合并糖尿病患者经皮冠状动脉介入治疗术后对比剂肾病的系统评价  

Systematic Review on Alprostadil in Prevention of Contrast-Induced Nephropathy After Percutaneous Coronary Intervention on Patients with Coronary Heart Disease Complicated with Diabetes

作　　者：司霞[1] 田攀攀 杨佳丽[1] 丁庆明[1] 冯婉玉[1] 

机构地区：[1]北京大学人民医院药剂科,北京100044

出　　处：《中国医院用药评价与分析》2018年第2期215-220,共6页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:系统评价前列地尔防治冠心病合并糖尿病患者经皮冠状动脉介入治疗术后对比剂肾病(contrast-induced nephropathy,CIN)的效果与安全性。方法:计算机检索Pubmed、EMbase、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库和万方数据库,收集前列地尔防治冠心病合并糖尿病患者经皮冠状动脉介入术后CIN的随机对照试验,提取资料并按照Cochrane系统评价员手册5.1.0评价质量后,采用Rev Man 5.3软件进行文献荟萃(Meta)分析。结果:纳入13篇文献,共1 463例患者。Meta分析结果显示,前列地尔组患者的CIN发生率明显低于对照组,差异有统计学意义(RR=0.37,95%CI=0.29~0.48,P<0.000 01)。治疗后,前列地尔组患者血肌酐(术后24、48和72 h)及血尿素氮(术后24和72 h)、血β_2微球蛋白(术后24、48和72 h)、尿β_2微球蛋白(术后72 h)及血清胱抑素C(术后24、48和72 h)水平明显低于对照组,肾小球滤过率(术后24、48和72 h)明显高于对照组,差异均有统计学意义(P<0.05)。安全性方面,与对照组比较,前列地尔可以明显降低再次行介入治疗率,差异有统计学意义(RR=0.34,95%CI=0.16~0.72,P=0.005);治疗过程中未见严重不良反应。结论:前列地尔防治冠心病合并糖尿病患者经皮冠状动脉介入治疗术后CIN安全、有效,可以降低CIN发生率,有效改善患者的肾功能。OBJECTIVE： To systematically review the efficacy and safety of alprostadil in prevention of contrastinduced nephropathy（ CIN） after percutaneous coronary intervention on patients with coronary heart disease complicated with diabetes. METHODS： Randomized controlled trials on alprostadil in prevention of CIN after percutaneous coronary intervention on patients with coronary heart disease complicated with diabetes were collected by retrieving Pub Med,EMbase,Cochrane Library,CBM,CNKI,VIP and Wanfang,quality evaluation was conducted in accordance with Cochrane System Evaluator＇s Manual 5. 1. 0 after extracted data,and Rev Man 5. 3 was adopted to carry out Meta analysis. RESULTS： 13 studies including 1 463 patients were involved. Results of Meta analysis indicated that the incidence of CIN of alprostadil group was significantly lower than that of the control group,with statistically significant difference（ RR = 0. 37,95% CI = 0. 29-0. 48,P 〈0. 000 01）. After treatment,contents of serum creatinine（ 24 h,48 h and 72 h after surgery）,blood urea nitrogen（ 24 h and 72 h after surgery）,serum β2microglobulin（ 24 h,48 h and 72 h after surgery）,urinary β2microglobulin（ 72 h after surgery）,serum cystatin C（ 24 h,48 h and 72 h after surgery） of alprostadil group were significantly lower than those of the control group,and the glomerular filtration rate of alprostadil group was significantly higher than that of the control group,with statistically significant differences（ P〈0. 05）. As for safety,compared with the control group,alprostadil can significantly reduce the rate of reintervention treatment,with statistically significant difference（ RR = 0. 34,95% CI = 0. 16-0. 72,P = 0. 005）; no severe adverse drug reactions were observed during the treatment process. CONCLUSIONS： Alprostadil is safe and effective in preventing CIN after percutaneous coronary intervention on patients with coronary heart disease complicated with diabetes,which can significantly improve patients＇ renal

关 键 词：前列地尔 冠心病 糖尿病 对比剂肾病 随机对照试验 

分 类 号：R972[医药卫生—药品]