促红细胞生成素治疗非透析慢性肾功能衰竭贫血的系统评价

摘要

Objective To evaluate the effectiveness and safety of erythropoietin (EPO) in non-dialysis patients with renal anaemia. Methods Randomized controlled trials were searched and identified from Chinese journal full-text database, Chinese biomedical literature database, Chinese scientific journals full-text database, PubMed, the Cochrane library, EMBASE and related journals. We evaluated the quality of the included studies by Handbook 5.0 recommended standard and analyzed dala by Cochrane collaboration's RevMan 5.0. Results We included thirteen trials (n = l 728). The baselines of each trial were comparable. Meta analysis showed that EPO vs. Place-bo: haemoglobin (P=0.003), hematocrit (P<0.000 01), kidney function (BUN P=0.09,Cr P=0.09), BP(systolic BP P= 0.000 3, diastolic BP P =0.001), serum iron(P=0.05), iransferrin saturation (P=0.002), adverse effect of dizziness (P=0.003); EPO vs. Different uses, different doses; haemoglobin (P=0.06), adverse effect of urinary tract in fection (P=0.58). Conclusion The current evidence showed that EPO is significantly beneficial to non-dialysis patients with renal anaemia. Well designed randomized controlled trials with a larger sample size, a longer intervention and follow-up period are still needed.%目的 系统评价促红细胞生成素对非透析慢性肾功能衰竭贫血的疗效和安全性.方法 计算机检索PubMed、EMBASE、Cochrane Librarv、SCI、中国期刊全文数据库、中文科技期刊全文数据库、中国生物医学文献数据库、数字化期刊全文数据库等数据库,按照纳入标准由两名研究者独立筛选并提取资料,采用Cochrane Handbook 5.0推荐的文献质量评价标准评价纳入的研究,采用RevMan 5.0软件进行统计学处理.结果 纳入1 3篇文献(包括1 728例患者).Meta分析结果显示:促红细胞生成素治疗组与安慰剂组相比,血红蛋白(P=0.003)、红细胞比容(P＜0.000 01)、血压(收缩压P=0.000 3.舒张压P=0.001),血清铁(P=0.05)、转铁蛋白饱和度(P=0.002)差异有统计学意义,肾功能(尿素氮P=0.09,肌酐P=0.09)无明显改善,可致头晕(P=0.003)；促红细胞生成素不同剂量、不同用法组间比较,血红蛋白(P=0.06)和尿路感染(P=0.58)无明显差异.结论 当前证据表明,促红细胞生成素对非透析慢性肾功能衰竭贫血有效.限于可合并的报道指标有限,还需要大样本高质量随机对照试验来进一步评价.