脑利钠肽预防造影剂肾病疗效的meta分析  

Efficacy of brain natriuretic peptide in the prevention of contrast-induced nephropathy:A meta-analysis

作　　者：巴文强 李艳 陈力群[1] 邓中华[1] 李梦媛[3] BA Wen-qiang;LI Yan;CHEN Li-qun;DENG Zhong-hua;LI Meng-yuan(Department of Pharmacy,Central People's Hospital of Ji'an,Ji'an Jiangxi 343000;Department of Psychiatry,Ji'an Third People's Hospital,Ji'an Jiangxi 343000;Department of Pharmacy,Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011)

机构地区：[1]吉安市中心人民医院药剂科,江西吉安343000 [2]吉安市第三人民医院精神科,江西吉安343000 [3]南京医科大学第二附属医院药学部,南京210011

出　　处：《中南药学》2021年第2期338-345,共8页Central South Pharmacy

摘　　要：目的系统评价脑利钠肽(BNP)或重组人脑利钠肽(rhBNP)预防造影剂肾病(CIN)的临床疗效。方法计算机检索PubMed、EMbase、the Cochrane Library、中国知网、万方、维普数据库,收集BNP或rhBNP预防CIN的随机对照试验(RCT),检索时间从建库至2020年7月。采用Stata 16.0软件对纳入的RCTs进行meta分析。结果共纳入12项RCTs,包括2714例受试者,其中rhBNP组1370例,对照组1344例,均接受冠状动脉造影(CAG)/经皮冠状动脉介入治疗(PCI)。Meta分析结果显示:与对照组相比,rhBNP能显著降低CAG/PCI术后患者的CIN发生率[log OR=-1.02,95%CI(-1.28,-0.76),P<0.001]和主要不良心血管事件(MACEs)发生率[log OR=-0.90,95%CI(-1.48,-0.31),P<0.001];同时能够减缓患者术后24 h[MD=-4.19,95%CI(-6.52,-1.86),P<0.001]、48 h[MD=-5.60,95%CI(-7.82,-3.38),P<0.001]及72 h[MD=-6.27,95%CI(-9.32,-3.22),P<0.001]血清肌酐(SCr)升高水平;能够减缓患者术后48 h[MD=-0.18,95%CI(-0.28,-0.07),P<0.001]及72 h[MD=-0.28,95%CI(-0.51,-0.05),P=0.02]胱抑素C升高水平;能够减缓患者术后72 h的估算肾小球滤过率降低水平[MD=4.63,95%CI(0.70,8.56),P=0.02]。结论rhBNP能够降低CAG/PCI术后患者的CIN和MACEs发生率,减缓患者术后肾功能损伤。Objective To systematically evaluate the efficacy of brain natriuretic peptide(BNP)or recombinant human brain natriuretic peptide(rhBNP)in preventing contrast-induced nephropathy(CIN).Methods Randomized controlled trials(RCT)about BNP or rhBNP in the prevention of CIN from establishment of the databases to July 2020 of PubMed,EMbase,the Cochrane Library,CNKI,WanFang Database and VIP were retrieved.meta-analysis was conducted with Stata 16.0 statistical software.Results Twelve RCTs involving 2714 subjects were included,and among them 1370 in the rhBNP group and 1344 in the control group.All the subjects received coronary angiography(CAG)/percutaneous coronary intervention(PCI).The meta-analysis indicated that compared with the control group,rhBNP decreased the incidence of CIN[log OR=-1.02,95%CI(-1.28,-0.76),P<0.001]and major adverse cardiovascular events(MACEs)[log OR=-0.90,95%CI(-1.48,-0.31),P<0.001];reduced the increased rate of serum creatinine(Scr)at 24 h[MD=-4.19,95%CI(-6.52,-1.86),P<0.001],48 h[MD=-5.60,95%CI(-7.82,-3.38),P<0.001]and 72 h[MD=-6.27,95%CI(-9.32,-3.22),P<0.001]after CAG/PCI;reduced the increased rate of cystatin C at 48 h[MD=-0.18,95%CI(-0.28,-0.07),P<0.001]and 72 h[MD=-0.28,95%CI(-0.51,-0.05),P=0.02]after CAG/PCI;reduced the decreased rate of estimated glomerular filtration rate at 72 h[MD=4.63,95%CI(0.70,8.56),P=0.02]after CAG/PCI.Conclusion rhBNP pretreatment can significantly reduce the incidence of CIN and MACEs and relieve damage of kidney function in patients after CAG/PCI.

关 键 词：脑利钠肽 重组人脑利钠肽 造影剂肾病 随机对照试验 META分析 

分 类 号：R96[医药卫生—药理学]