药物干预措施预防冠心病介入术后对比剂相关急性肾损伤效果的系统评价再评价  

Efficacy of different pharmacological interventions in the prevention of contrast-induced acute kidney injury after percutaneous coronary intervention:an overview of systematic reviews

作　　者：梁士楚 张静[1] 李静[2] 马敏[1] 陈忠兰[1] 贺勇[1] 黄鹤[1] LIANG Shichu;ZHANG Jing;LI Jing;MA Min;CHEN Zhonglan;HE Yong;HUANG He(Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Research Center of Evidence-Based Medicine and Clinical Epidemiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院心脏内科,成都610041 [2]四川大学华西医院循证医学与临床流行病学研究中心,成都610041

出　　处：《中国循证医学杂志》2022年第5期575-584,共10页Chinese Journal of Evidence-based Medicine

基　　金：中国博士后科学基金项目(编号:2020M683325);四川大学华西医院专职博士后研发基金(编号:2020HXBH048);2020年四川省医学(青年创新)科研课题(编号:Q20061);四川省科技厅项目(编号:2019YFS0414、2017JY0026)。

摘　　要：目的对不同药物干预措施预防冠心病经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后对比剂相关急性肾损伤(contrast-induced acute kidney injury,CI-AKI)进行系统评价再评价。方法计算机检索PubMed、The Cochrane Library、EMbase、CNKI、CBM、WanFang Data和VIP数据库,搜集各药物预防PCI术后CI-AKI的系统评价(systematic review,SR)/Meta分析,检索时限均从建库至2022年2月。由2位评价员独立筛选文献、提取资料并应用PRISMA声明、AMSTAR 2工具和GRADE对纳入研究的报告质量、方法学质量和证据级别进行评价。结果最终共纳入14个SR/Meta分析,药物涉及他汀类、N-乙酰半胱氨酸、碳酸氢钠、丹红注射液联合水化、维生素类、丹参多酚酸盐联合水化、茶碱类、尼克地尔、别嘌呤醇联合水化、前列地尔联合水化、呋塞米联合水化、曲美他嗪、普罗布考和脑利钠肽。纳入研究的报告质量方面,PRISMA得分介于18~24.5分,问题主要在方案和注册、检索和资助来源。方法学质量方面,纳入SR/Meta分析的方法学质量总体偏低,其中存在较大缺陷的关键条目为2和7,非关键条目为3、10和16。除呋塞米联合水化外大部分药物可有效降低CI-AKI发生率,GRADE评价结果显示证据质量为中等质量到极低质量。结论药物对预防CI-AKI具有一定成效,但相关研究的方法学质量较低,尚缺乏高质量证据支持。Objective To analyze systematic reviews(SRs)and meta-analyses on the efficacy of pharmacological interventions in the prevention of contrast-induced acute kidney injury(CI-AKI)after percutaneous coronary intervention(PCI).Methods We searched the PubMed,The Cochrane Library,EMbase,CNKI,CBM,WanFang Data,and VIP databases to identify SRs and meta-analyses on the pharmacological interventions aimed at preventing CI-AKI after PCI from inception of the databases to February 2022.Two researchers independently screened the literature and extracted data.The PRISMA statement,AMSTAR 2 tool,and GRADE system were adopted to evaluate the reporting quality,methodological quality,and evidence quality of the findings of the included SRs and meta-analyses.Results A total of 14 SRs and meta-analyses were identified.Among the drugs used were statins,N-acetylcysteine,sodium bicarbonate,Dan-hong injection,vitamins,salvianolate,adenosine antagonists,nicorandil,allopurinol,alprostadil,furosemide,trimetazidine,probucol,and brain natriuretic peptide.Most of the studies had relatively comprehensive coverage of the items,with the PRISMA scores ranging from 18 to 24.5.The main issues of reporting quality were protocol and registration,search,and funding.The methodological quality of the SRs and meta-analyses was generally low.Items 2and 7 were the key items with poor scores,and the non-critical items with poor scores were items 3,10,and 16.All drugs,except furosemide,decreased the incidence of CI-AKI.The quality of evidence ranged from medium to very low according to GRADE.Conclusion Most of the single drugs or drugs combined with hydration show the potential to prevent CIAKI,however,the overall methodological quality of the included studies is relatively low,and the strength of evidence is generally low.

关 键 词：对比剂相关急性肾损伤 冠状动脉粥样硬化性心脏病 经皮冠状动脉介入治疗 系统评价再评价 

分 类 号：R541.4[医药卫生—心血管疾病] R692[医药卫生—内科学]