短期大剂量他汀类药物对冠状动脉造影对比剂肾病预防作用的荟萃分析

短期大剂量他汀类药物对冠状动脉造影 患者对比剂肾病预防作用的荟萃 分析 定性数据统计分析pdf销售业绩分析模板建筑结构震害分析销售进度分析表京东商城竞争战略分析 周益 袁伟杰 [摘要] 目的 探讨短期(2～7 d)大剂量(80 mg/d)他汀类药物对冠状动脉（冠脉）造影患者发 生对比剂肾病(CIN)的预防作用。方法 以“statins/statin/HMG-CoA reductase inhibitor”、“contrast”和 “nephropathy/nephrosis/nephrotoxicity/kidney failure”为关键词，查找1966年至2010年PubMed、 Embase、ScienceDirect、Wiley InterScience、Scopus和Ovid数据库的RCT，无语言限制。2位评价者评价 每一项研究的质量并提取数据。结果5项RCT共计1009例患者被纳入研究。按血肌酐(SCr)水平 进行分层研究显示，慢性肾脏病(CKD)3 ～5期(GFR≤60 ml/min或SCr≥97.2 μmol/L)患者使用他 汀类药物后CIN的发生率差异没有统计学意义（治疗组6.5％比对照组7.2％，RR =0. 89），且入选研 究没有异质性(I2=0％,P= 0.79)；CKD 1 ～2期(GFR ＞60 ml/min)患者使用他汀类药物CIN的发生 率显著低于对照组，差异有统计学意义（治疗组3.6％比对照组11.9％，RR =0. 28），入选研究也无异 质性(I2=0％，P =0. 87)。结论短期大剂量应用他汀类药物可预防CKD 1～2期冠脉造影患者CIN 的发生，而对CKD 3～5期的患者无显著预防作用。 造影剂；肾疾病；羟甲基戊二酰基CoA还原酶抑制剂；Meta分析；系统评价 The effects of short-term high-dose statins on the prevention of contrast-induced nephropathy in patients undertaking coronary angiography: a systematic review and meta-analysis ZHOU Yi YUAN Wei-jie Department of Nephrology, the First People' s Hospital, Shanghai Jiaotong University, Sha ngha i 20 0080 , Ch ina <英 文摘 要> [ Abst ract] O bjec tive To ass ess t he e ffec ts o f sh ort- term (2-7 d) high -dos e (8 0 mg/ d) s tati ns i n the pre vent ion of c ontra st-i nduc ed n ephr opat hy ( CIN) . Me thod s We searc hed PubM ed, Emb ase, Sci ence Dire ct, Scop us, O vid and Wil ey Inte rScie nce with the key wor ds o f “ sta tins /sta tin/ HMG-C oA red ucta se inhi bito r” , “co ntra st ” and “ n ephr opat hy/n ephr osis/ neph roto xici ty/k idne y fa ilur e” i n a ll lan guag es f rom 1996 t0 2 010 for RCT that ass essed the pre vent ive effe ct of sho rt-t erm (2-7 d) high -dos e( 8 0 mg/ d) s tati ns o n CI N. Re sult s F ive tria ls w ith a tot al o f 10 09 p atie nts w ere iden tifi ed Two studi es w ere con duct ed i n pa tien ts wi th C KD 3 -5 s tage s ( GFR≤ 60 m l/mi n or ser um c reati nine ≥97 . 2 μmo l/L) and the rem aini ng 3 stu dies were con duct ed i n pa tien ts wi th C KD l and 2 s tage s. A naly sis of t he d ata in pa tien ts w ith CKD 3-5 sta ges did not r evea l a stat isti call y sig nifi cant dif fere nce in CI N in cide nce betw een the s tati ns a nd pla cebo gro ups (6. 50％ vs 7. 2 ％ ) . T he r elati ve r isk ( RR ) w as 0 . 89 with out evid ence of heter ogen eity (12 =Oq o , P=O. 79) . An alys is o f th e da ta i n pat ient s wi th C KD I and 2 st ages rev eale d a sign ifica ntly low er C IN i ncid ence in t he s tati ns g roup ( 3. 60 -/o ) t han that in the p lace bo g roup ( 11. 9％ ) . T he R R wa s 0. 28 w itho ut e vide nce o f he tero gene ity ( I 2 = 0% , P = 0. 87 ) . Con clus ion Shor t-te rm h igh- dose st atin s tre atme nt m ay b e be nefic al i n re duci ng t he i ncide nce of C IN i n pa tien ts wi th C KD l and 2 s tage s, wh ile no ben efit has bee n sh own i n th e pa tien ts w ith CKD 3 -5 s tage s. <英 文关 键词 > [ K ey wo rds] C ontr ast medi a; Kidn ey d isea ses; H ydrox ymet hylg luta ryl- CoA reduc tase inh ibit ors; 10. 3760/cma. j. issn. 0578-1426. 2011.11. 010 200080 上海交通大学附属第一人民医院肾内科 万方数据 ·943· 万方数据 ·944· 万方数据 ·945· 万方数据 @@[ 1 ] McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol, 2008,51 : 1419-1428. @@[2] Marenzi G, Lauri G, Assanelli E, et al. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol, 2004, 44:1780-1785. @@[3] Subramanian S, Tumlin J, Bapat B, et al. Economic burden of contrast-induced nephropathy: implications for prevention strategies. J Med Econ,2007,10 : 119-134. @@[4] Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation, 2002,105:2259-2264. @@[5 ] Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 0. 2 [ DB/OL ]. The Cochrane Collaboration, 2008 [ 2011-07-13 ]. http://www. cochrane handbook. org. @@[6] Jo SH, Koo BK, Park JS, et al. Prevention of radiocontrast medium-induced nephropathy using short-term high-dose simvastatin in patients with renal insufficiency undergoing coronary angiography (PROMISS) trial--a randomized controlled study. Am Heart J, 2008,155:499, e1-8. @@[7] Toso A, Maioli M, Leoncini M, et al. Usefulness of atorvastatin (80 mg) in prevention of contrast-induced nephropathy in patients with chronic renal disease. Am J Carlid, 2010,105:288-292. @@[8] Xinwei J, Xianghua F, Jing Z, et al. Comparison of usefulness of simvastatin 20 mg versus 80 mg in preventing contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Cardiol, 2009, 104: 519-524. @@[9] Ozhan H, Erden I, Ordu S, et al. Efficacy of short-term high-dose atorvastatin for prevention of contrast-induced nephropathy in patients undergoing coronary angiography. Angiology, 2010, 61: 711-714. @@[10]周霞，金元哲，王琦，等.大剂量阿托伐他汀预防对比剂肾 病.中华心血管病杂志，2009, 37：394-398. @@[ 11 ] Bakris GL, Lass N, Gaber AO, et al. Radiocontrast medium induced declines in renal function: a role for oxygen free radicals. Am J Physiol, 1990, 258: 115-120. @@[12] Weisberg LS, Kumik PB, Kumik BR. Radiocontrast-induced nephropathy in humans: role of renal vasoconstriction. Kidney Int, 1992, 41 : 1408-1415. @@[13] Dawnay AB, Thornley C, Nockler I, et al. Tamm-Horsfall glycoprotein excretion and aggregation during intravenous urography. Relevance to acute renal failure. Invest Radiol, 1985, 20: 53-57. @@[14] Clark BA, Kim D, Epstein FH. Endothelin and atrial natriuretic peptide levels following radiocontrast exposure in humans. Am J Kidney Dis, 1997, 30: 82-86. @@[15] Zager RA, Johnson AC, Hanson SY. Radiographic contrast media-induced tubular injury: evaluation of oxidant stress and plasma membrane integrity. Kidney Int, 2003,64: 128-139. @@[16] Attallah N, Yassine L, Musial J, et al. The potential role of statins in contrast nephropathy. Clin Nephrol, 2004, 62:273- 278. @@[17] Khanal S, Attallah N, Smith DE, et al. Statin therapy reduces contrast-induced nephropathy: an analysis of contemporary percutaneous interventions. Am J Med, 2005, 118:843- 849. @@[18] Patti G, Nusca A, Chello M, et al. Usefulness of statin pretreatment to prevent contrast-induced nephropathy and to improve long-term outcome in patients undergoing percutaneous coronary intervention. Am J Cardiol, 2008, 101 : 279-285. @@[19] Cochran ST, Wong WS, Roe DJ. Predicting angiography-induced acute renal function impairment: clinical risk model. Am J Roentgenol, 1983,141:1027-1033. @@[20] Zhou MS, Schuman IH, Jaimes EA, et al. Renoprotection by statins is linked to a decrease in renal oxidative stress, TGF-beta, and fibronectin with concomitant increase in nitric oxide bioavailability. Am J Physiol Renal Physiol, 2008, 295 : 53-59. @@[21] Sandhu S, Wiebe N, Fried LF, et al. Statins for improving renal outcomes: a meta-analysis. J Am Soc Nephrol,2006, 17:2006- 2016. @@[22] Navaneethan SD, Pansini F, Perkovic V, et al. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev, 2009 Apr 15 ; (2) :CD007784. @@[23] Lautin EM, Freeman NJ, Schoenfeld AH, et al. Radiocontrast associated renal dysfunction: incidence and risk factors. Am J Roentgenol,1991,157 :49-58. 2011-02-14 万方数据 短期大剂量他汀类药物对冠状动脉造影患者对比剂肾病预防作用的荟 萃分析 作者： 周益， 袁伟杰， ZHOU Yi， YUAN Wei-jie 作者单位： 200080,上海交通大学附属第一人民医院肾内科 刊名： 中华内科杂志 英文刊名： Chinese Journal of Internal Medicine 年，卷(期)： 2011,50(11) 参考文献(23条) 1.McCullough PA Contrast-induced acute kidney injury[外文期刊] 2008(15) 2.Marenzi G;Lauri G;Assanelli E Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction[外文期刊] 2004(9) 3.Subramanian S;Tumlin J;Bapat B Economic burden of contrast-induced nephropathy:implications for prevention strategies[外文期刊] 2007 4.Rihal CS;Textor SC;Grill DE Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention[外文期刊] 2002 5.Higgins JPT;Green S Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 2008 6.Jo SH;Koo BK;Park JS Prevention of radiocontrast medium-induced nephropathy using short-term high-dose simvastatin in patients with renal insufficiency undergoing coronary angiography (PROMISS) trial--a randomized controlled study[外文期刊] 2008 7.Toso A;Maioli M;Leoncini M Usefulness of atorvastatin (80 mg) in prevention of contrast-induced nephropathy in patients with chronic renal disease[外文期刊] 2010 8.Xinwei J;Xianghua F;Jing Z Comparison of usefulness of simvastatin 20 mg versus 80 mg in preventing contrast- induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention[外文期 刊] 2009 9.Ozhan H;Erden I;Ordu S Efficacy of short-term high-dose atorvastatin for prevention of contrast-induced nephropathy in patients undergoing coronary angiography 2010 10.周霞;金元哲;王琦 大剂量阿托伐他汀预防对比剂肾病[期刊 论文 政研论文下载论文大学下载论文大学下载关于长拳的论文浙大论文封面下载 ]-中华心血管病杂志 2009(5) 11.Bakris GL;Lass N;Gaber AO Radiocontrast mediuminduced declines in renal function:a role for oxygen free radicals 1990 12.Weisberg LS;Kumik PB;Kumik BR Radiocontrast-induced nephropathy in humans:role of renal vasoconstriction[外文期 刊] 1992 13.Dawnay AB;Thornley C;Nockler I Tamm-Horsfall glycoprotein excretion and aggregation during intravenous urography.Relevance to acute renal failure[外文期刊] 1985 14.Clark BA;Kim D;Epstein FH Endothelin and atrial natriuretic peptide levels following radiocontrast exposure in humans[外文期刊] 1997 15.Zager RA;Johnson AC;Hanson SY Radiographic contrast media-induced tubular injury:evaluation of oxidant stress and plasma membrane integrity[外文期刊] 2003 16.Attallah N;Yassine L;Musial J The potential role of statins in contrast nephropathy[外文期刊] 2004(4) 17.Khanal S;Attallah N;Smith DE Statin therapy reduces contrast-induced nephropathy:an analysis of contemporary percutaneous interventions[外文期刊] 2005 18.Patti G;Nusca A;Chello M Usefulness of statin pretreatment to prevent contrast-induced nephropathy and to improve long-term outcome in patients undergoing percutaneous coronary intervention[外文期刊] 2008(3) 19.Cochran ST;Wong WS;Roe DJ Predicting angiography-induced acute renal function impairment:clinical risk model 1983 20.Zhou MS;Schuman IH;Jaimes EA Renoprotection by statins is linked to a decrease in renal oxidative stress,TGF- beta,and fibronectin with concomitant increase in nitric oxide bioavailability 2008 21.Sandhu S;Wiebe N;Fried LF Statins for improving renal outcomes:a meta-analysis[外文期刊] 2006(7) 22.Navaneethan SD;Pansini F;Perkovic V HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis 2009(02) 23.Lautin EM;Freeman NJ;Schoenfeld AH Radiocontrastassociated renal dysfunction:incidence and risk factors 1991 本文读者也读过(2条) 1. 姚青海.吴尚勤.孙姗.程爱娟.董国峰 他汀类药物预防对比剂肾病的最新进展[期刊论文]-中华老年心脑血管病杂志2011,13(3) 2. 汤绍辉.张嫚嫚.吴小娟.王旷靖.TANG Shao-hui.ZHANG Man-man.WU Xiao-juan.WANG Kuang-jing 血管紧张素Ⅱ受体拮抗剂治疗 肝硬化门静脉高压症疗效和安全性的荟萃分析[期刊论文]-中华内科杂志2011,50(12) 本文链接：http://d.g.wanfangdata.com.cn/Periodical_zhnk201111010.aspx