中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (03): 129-133.doi: 10.3969/j.issn.1671-4091.2014.03.001

• 临床研究 •    下一篇

帕立骨化醇对血液透析患者继发性甲状旁腺功能亢进的疗效的Meta分析

王喆,姜埃利,魏芳,陈海燕   

  1. 天津医科大学第二医院 肾脏病血液净化治疗中心
  • 收稿日期:2013-11-19 出版日期:2014-03-12 发布日期:2014-03-12
  • 通讯作者: 姜埃利 aili-j@hotmail.com E-mail:aili-j@hotmail.com

Efficacy of Paricalcitol Therapy for Hemodialysis Patients with Secondary Hyperparathyroidism: A Meta-analysis

  • Received:2013-11-19 Online:2014-03-12 Published:2014-03-12

RichHTML

0

PDF

415

摘要： 目的:系统评价新型维生素D类似物帕立骨化醇对维持性血液透析患者继发性甲状旁腺功能亢进的疗效。方法:检索计算机检索MEDLINE（1966-2013.9）、OVID(1963-2013.9)、中文万方数据库（1996-2013.9）、CNKI（1979-2013.9）、Cochrane图书馆临床对照试验资料库。手工检索已发表或未发表的相关文献，包括会议摘要等。纳入帕立骨化醇和经典维生素D对维持性血液透析患者继发性甲状旁腺功能亢进疗效的随机对照试验。由两名评价员独立对纳入的文献进行质量评价和数据提取，用RevMan5.0软件进行Meta分析。结果:共纳入5项随机对照试验，共计452例患者。Meta分析结果显示:帕立骨化醇与经典维生素D（阿法骨化醇/骨化三醇）比较，降低甲状旁腺素的疗效差异无统计学意义[WMD=-0.63，95%CI（-2.20～0.93），P=0.43]。帕立骨化醇可升高血钙[WMD=-2.92，95%CI（-16.64～10.8），P=0.007]，降低血磷 [WMD=-0.05，95%CI（-0.08～-0.03），P=0.0001]，但高钙血症和高磷血症的发生率无明显差异[RR=0.95，95%CI（0.83～1.08），P=0.45]。结论:帕立骨化醇对维持性血液透析患者继发性甲状旁腺功能亢进的治疗安全有效。

关键词: 帕立骨化醇, 血液透析, 终末期肾病, 继发性甲状旁腺功能亢进, Meta 分析

Abstract: Objective To systematically evaluate the effect of paricalcitol on secondary hyperparathyroidism in chronic hemodialysis patients. Methods According to the collaborative search strategy, MEDLINE (1996- 2013.9), OVID (1963- 2013.9), Chinese Wanfang database (1996- 2013.9), CNKI (1996- 2013.9), and the clinical control test database of Cochrane Library were searched. Published and unpublished literature and abstracts in academic meetings were also searched by hand. Quality assessment and data extraction were conducted by two independent investigators. Meta-analysis was performed by the software RevMan 5.0. Results Five randomized controlled trials including 452 patients were analyzed. Meta- analysis showed that the decrease of parathyroid hormone was similar between chronic hemodialysis patients with paricalcitol therapy and those with alfacalcidol/calcitriol therapy (WMD = -0.63, 95% CI -2.20～0.93, P=0.43), and paricalcitol could effectively increase serum calcium (WMD = -2.92, 95% CI -16.64～10.8, P=0.007) and decrease serum phosphorus (WMD = -0.05, 95% CI  0.08～-0.03, P=0.0001). However, the remission rates of hypercalcemia and hyperphosphatemia were similar between the two therapies (RR = 0.95, 95% CI 0.83～1.08, P=0.45). Conclusion The meta-analysis suggests that paricalcitol suppresses parathyroid hormone and decreases serum phosphorus without the increase of adverse events in chronic hemodialysis patients.

Key words: Paricalcitol, Hemodialysis, End-stage renal disease, Secondary hyperparathyroidism, Meta-analysis