不同水化疗法预防造影剂肾病的Meta分析

摘要

目的 进一步Meta分析评估不同水化疗法对造影剂肾病(CIN)的预防作用.方法 系统检索PUBMED、Ovid以及Cochrane图书馆的临床试验注册中心以及中国期刊全文数据库(CNKI)、维普数据库(VIP)和万方数据库中关于不同水化疗法预防CIN的临床随机对照试验.运用Jadad评分标准对纳入文献进行方法学质量评价.以CIN发生的相对危险度作为效应尺度.采用RevMan 5.0和Stata 11.0软件进行Meta分析.结果 共纳入10项RCT研究.根据Japad评分,各研究均为高质量研究.Meta分析结果显示,与生理盐水相比,碳酸氢钠可能有助于降低CIN的发生风险,但亚组分析结果不一致,提示研究结果欠稳定；与单纯生理盐水相比,碳酸氢钠联合生理盐水在降低CIN的发生风险方面没有明显优势.结论 无论是碳酸氢钠还是碳酸氢钠联合生理盐水,目前尚无证据表明它们优于生理盐水对于CIN的预防.%Objective To evaluate the effect of different hydration regimes for the prevention of contrast-induced nephropathy (CIN) through Meta-analysis. Methods We searched PubMed (1951 to June 2012), Ovid (1966 to June 2012) and the Gochrane Central Register of Controlled Trials (CENTRAL-The Cochrane Library issue 5, 2012), as well as Chinese literature database such as CNKI, VIP, Wanfang for randomized controlled trials (RCTs) comparing different hydration regimes for the prevention of CIN. The Jadad score was used to assess the methodological quality of these clinical trials. RevMan 5.0 and Stata 11.0 were used for meta-analysis. Results A total of 10 trials including 1,837 subjects were included. According to the Jadad score, all the trials were high-quality studies. When pooled, compared with normal saline (NS), sodium bicarbonate (SB) may decrease the rate of CIN. However, the results of subgroup analysis were discordant. Moreover, SB combined with NS had no advantage over NS for the prevention of CIN. Conclusion According to the current data, neither SB nor SB combined with NS had a significant advantage for the prevention of CIN.