预防使用质子泵抑制剂对慢性肾脏病患者上消化道出血有效性和安全性的Meta分析
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篇名: 预防使用质子泵抑制剂对慢性肾脏病患者上消化道出血有效性和安全性的Meta分析
TITLE:
摘要: 目的:系统评价预防使用质子泵抑制剂(PPI)对慢性肾脏病(CKD)患者上消化道出血的有效性和安全性,为临床合理用药提供循证参考。方法:计算机检索PubMed、Cochrane图书馆、中国期刊全文数据库、中国生物医学文献数据库和维普数据库,收集预防使用PPI(试验组)对比空白对照(对照组)用于CKD患者的随机对照试验(RCT)或队列研究,筛选文献并提取资料后,采用纽卡斯尔-渥太华量表(NOS)评价文献质量,进而采用Stata 14.0软件进行Meta分析。 结果:共纳入14项队列研究,共计13 740例患者。试验组患者上消化道出血发生率[RR=0.16,95%CI(0.07,0.34),P<0.01]、血肌酐水平[WMD=-62.14,95%CI    (-86.98,-37.30),P<0.01]均显著低于对照组,碱性磷酸酶水平[WMD=51.25,95%CI(10.72,91.78),P=0.01]显著高于对照组;两组患者病死率[RR=1.08,95%CI(0.83,1.40),P=0.56]、血钙浓度[WMD=-0.14,95%CI(-0.37,0.08),P=0.22]、血磷浓度[WMD=0.03,95%CI(-0.08,0.14),P=0.60]、血镁浓度[WMD=-0.06,95%CI(-0.22,0.10),P=0.44]、甲状旁腺激素水平[WMD=7.85,95%CI(-24.88,40.58),P=0.64]、肾小球滤过率[WMD=3.97,95%CI(-6.87,14.81),P=0.47]比较,差异均无统计学意义。结论:预防使用PPI能有效降低CKD患者上消化道出血的发生风险,不会增加肾功能异常的发生风险或加重电解质紊乱;但不能降低患者的病死率,且有增高碱性磷酸酶水平的风险。
ABSTRACT: OBJECTIVE: To evaluate efficacy and saftey of prophylactic use of proton pump inhibitor (PPI) for upper gastrointestinal hemorrhage in patients with chronic kidney disease (CKD) systematically, and to provide evidence-based reference in clinic. METHODS: Retrieved from PubMed, Cochrane library, CNKI, CBM and VIP, randomized controlled trials (RCTs) or cohort study about prophylactic use of PPI (trial group) compared with blank control (control group) for upper gastrointestinal hemorrhage in CKD patients were collected. After literature screening, data extraction and literature quality evaluation with NOS scale, Meta-analysis was performed by using Stata 14.0 software. RESULTS: Fourteen cohort studies were included, involving 13 740 patients in total. The incidence of upper gastrointestinal hemorrhage [RR=0.16,95%CI(0.07,0.34),P<0.01] and serum creatinine [WMD=-62.14,95%CI(-86.98,-37.30),P<0.01] in trial group were significantly lower than control group; the levels of alkaline phosphatase [WMD=51.25, 95%CI(10.72,91.78), P=0.01] in trial group was significantly higher than control group. There was no statistical significance in the mortality [RR=1.08,95%CI(0.83,1.40),P=0.56], blood calcium concentration [WMD=-0.14, 95%CI(-0.37,0.08), P=0.22], blood phosphorus concentration [WMD=0.03, 95%CI(-0.08,0.14), P=0.60], blood magnesium concentration [WMD=-0.06, 95%CI(-0.22,0.10), P=0.44], the level of parathyroid hormone [WMD=7.85, 95%CI(-24.88,40.58), P=0.64] or glomerular filtration rate [WMD=3.97, 95%CI(-6.87,14.81),P=0.47] between 2 groups. CONCLUSIONS: The prophylactic use of PPI can effectively reduce the risk of upper gastrointestinal hemorrhage in CKD patients, without increasing the risk of renal function disorder, aggravating electrolyte disorder or reducing the incidence of death, but with the risk of increasing the level of alkaline phosphatase.
期刊: 2018年第29卷第24期
作者: 聂丹,赵奎,杨小军
AUTHORS: NIE Dan,ZHAO Kui,YANG Xiaojun
关键字: 质子泵抑制剂;预防使用;慢性肾脏病;上消化道出血;有效性;安全性;Meta分析
KEYWORDS: Proton pump inhibitor; Prophylactic use; Chronic kidney diseases; Upper gastrointestinal hemorrhage; Efficacy; Safety; Meta-analysis
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