骨化三醇对维持性血液透析患者微炎症及钙磷代谢疗效的meta分析  

Effect of calcitriol on mico-inflammation and calcium-phosphorus metabolism in maintenance hemodialysis patients,a meta-analysis

作　　者：林绮婷 谭荣韶[2] LIN Qiting;TAN Rongshao(Department of Nephrology,Guangzhou Red Cross Hospital,Jinan University,Guangdong Province,Guangzhou510220,China;Department of Nutrition,Guangzhou Red Cross Hospital,Jinan University,Guangdong Province,Guangzhou510220,China)

机构地区：[1]暨南大学附属广州红十字会医院肾内科,广东广州510220 [2]暨南大学附属广州红十字会医院营养科,广东广州510220

出　　处：《中国当代医药》2022年第36期13-17,共5页China Modern Medicine

基　　金：广东省体育局科研项目(GDSS2020M003)。

摘　　要：目的 系统评价骨化三醇对维持性血液透析(MHD)患者微炎症及钙磷代谢的疗效。方法 计算机检索万方、中国知网、中国生物医学文献数据库、维普网中文数据库,以及Pub Med、Cochrane Library、EMBase外文数据库关于使用骨化三醇对MHD患者微炎症状态及钙磷影响的随机对照试验(RCT),检索时间为建库至2022年3月。治疗组以骨化三醇为干预措施,对照组给予常规治疗或安慰剂,采用Rev Man 5.3软件进行数据分析。结果 最终纳入10篇随机对照试验,共722例患者,其中治疗组362例,对照组360例。meta分析结果显示:治疗组的C-反应蛋白(CRP)水平[SMD=-2.27,95%CI(-3.13,-1.42)]、白介素-6水平(IL-6)[SMD=-42.31,95%CI(-60.88,-23.74)]、甲状旁腺素(PTH)水平[SMD=-54.08,95%CI(-69.88,-38.27)]低于对照组,差异有统计学意义(P<0.000 01);治疗组的肿瘤坏死因子-α水平(TNF-α)低于对照组,差异有统计学意义[SMD=-1.74,95%CI(-2.85,-0.64),P=0.002];治疗组的血清钙(Ca2+)水平高于对照组,差异有统计学意义[SMD=0.18,95%CI(0.10,0.25),P<0.000 01],治疗组的血清磷(P5+)水平低于对照组,差异无统计学意义[SMD=-0.05,95%CI(-0.11,0.02),P=0.15]。结论 骨化三醇在降低维持性血液透析患者微炎症状态及PTH水平有一定疗效,但可引起Ca2+水平升高,仍需更多大样本多中心随机对照研究以证明。Objective To evaluate the efficacy of calcitriol on micro-inflammatory state and calcium-phosphorus metabolism in maintenance hemodialysis(MHD) patients. Methods Randomized controlled trials(RCTs) regarding the effect of calcitriol on micro-inflammatory state and calcium-phosphorus metabolism of MHD patients were retrieved from Wanfang, CNKI,Sino Med, VIP, and Pub Med, Cochrane Library, EMBase foreign databases from inception to March 2022. The experimental group was intervened by calcitriol, and the control group treated with conventional therapy or placebo.Data analysis was performed using Rev Man 5.3 software. Results Ten randomized controlled trials involving 722 patients were included, with362 patients in the treatment group and 360 patients in the control group.The Meta-analysis results illustrated that C-reactive protein(CRP)(SMD=-2.27, 95% CI [-3.13,-1.42]), interleukin-6(IL-6)(SMD=-42.31, 95% CI [-60.88,-23.74]), and parathyroid hormone(PTH)(SMD=-54.08, 95%CI [-69.88,-38.27]) in the treatment group were lower than those in the control group, and the differences were statistically significant(P<0.000 01). Tumor necrosis factor-α(TNF-α)in the treatment group was lower than that in the control group, and the difference was statistically significant(SMD=-1.74,95%CI [-2.85,-0.64], P=0.002). Serum calcium(Ca2+) in the treatment group was higher than that in the control group, and the difference was statistically significant(SMD=0.18, 95%CI [0.10, 0.25], P<0.000 01). Serum phosphorus(P5+) in the treatment group was lower than that in the control group, and it was not statistically significant difference(SMD=-0.05, 95%CI [-0.11, 0.02], P=0.15). Conclusion Calcitriol has a certain effect on reducing microinflammatory state and PTH level in maintenance hemodialysis patients, but it can cause Ca2+elevation. More large sample multi-center randomized controlled trials are needed to prove it.

关 键 词：微炎症 骨化三醇 血液透析 维生素D META分析 

分 类 号：R692[医药卫生—泌尿科学]