尼可地尔对冠脉造影或支架植入术后造影剂肾病预防作用的Meta分析
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篇名: 尼可地尔对冠脉造影或支架植入术后造影剂肾病预防作用的Meta分析
TITLE: Prevention effects of nicorandil on contrast-induced nephropathy after coronary angiography or stent implantation : a meta-analysis
摘要: 目的 系统评价尼可地尔对冠脉造影或支架植入术后造影剂肾病的预防作用,为临床用药提供循证参考。方法计算机检索PubMed、Embase、Cochrane图书馆、万方数据库、中国生物医学文献数据库和中国知网,搜集尼可地尔(试验组)对比生理盐水或安慰剂(对照组)预防冠脉造影或支架植入术后造影剂肾病的随机对照试验(RCT),检索时限均为建库起至2021年11月。对符合纳入标准的文献进行资料提取后,采用Cochrane手册中的RCT偏倚风险评估工具进行质量评价,采用RevMan5.3软件进行Meta分析。结果共纳入17项RCT,包括3279例患者,其中试验组1587例、对照组1692例。Meta分析结果显示,试验组造影剂肾病的发生率显著低于对照组[RR=0.40,95%CI(0.31,0.51),P<0.00001];亚组分析结果显示,无论采用静脉给药[RR=0.47,95%CI(0.29,0.74),P=0.001]还是口服给药[RR=0.37,95%CI(0.28,0.50),P<0.00001],无论是肾功能正常患者[RR=0.42,95%CI(0.30,0.59),P<0.00001]还是肾功能不全患者[RR=0.38,95%CI(0.26,0.54),P<0.00001],试验组患者的造影剂肾病发生率均显著低于对照组。试验组患者术后24h[SMD=-1.38,95%CI(-2.32,-0.44),P=0.004]、48h[SMD=-0.81,95%CI(-1.19,-0.43),P<0.0001]、72h[SMD=-0.24,95%CI(-0.43,-0.05),P=0.01]的肌酐水平均显著低于对照组,术后48h[SMD=1.27,95%CI(0.48,2.07),P=0.001]、72h[SMD=0.37,95%CI(0.07,0.67),P=0.02]的肌酐清除率下降程度均显著低于对照组,术后24h[SMD=-0.93,95%CI(-1.72,-0.14),P=0.02]、48h[SMD=-1.72,95%CI(-2.33,-1.10),P<0.00001]、72h[SMD=-0.36,95%CI(-0.62,-0.10),P=0.006]的胱抑素C水平均显著低于对照组。结论尼可地尔预处理降低了冠脉造影或支架植入术后造影剂肾病的发生率,并且减少了患者应用造影剂后肾功能的损伤。
ABSTRACT: OBJECTIVE To syste matically evaluate the prevention effects of nicorandil on contrast-induced nephropathy in patients underwent coronary angiography (CAG)or stent implantation (CSI),and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed ,Embase,Cochrane library ,Wanfang database ,CBM and CNKI ,randomized controlled trial (RCT)about nicorandil (trial group )versus normal saline or placebo (control group )prevented contrast-induced nephropathy in patients underwent CAG or CSI were collected during the inception to Nov. 2021. After extracting literature that met the inclusion criteria ,the bias risk assessment tool of RCT in Cochrane manual was used for quality evaluation ,and meta-analysis was performed by using RevMan 5.3 software. RESULTS A total of 17 RCTs were included ,involving 3 279 patients. Among them,there were 1 587 patients in trial group ,and 1 692 patients in control group. Results of meta-analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lo wer than control group [RR =0.40,95%CI(0.31,0.51), P<0.000 1] . Results of subgroup analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lower than control group ,whether intravenous administration [RR =0.47,95%CI(0.29,0.74),P=0.001] or oral administration [RR =0.37,95%CI(0.28,0.50),P<0.000 01],whether patients with normal renal function [RR =0.42,95%CI(0.30, 0.59),P<0.000 01] or with renal insufficiency [RR =0.38, 95% CI(0.26,0.54),P<0.000 01]. Scr of 24 h[SMD= -1.38,95%CI(-2.32,-0.44),P=0.004],48 h[SMD= -0.81,95%CI(-1.19,-0.43),P<0.000 1] and 72 h[SMD= -0.24,95%CI(-0.43,-0.05),P=0.01] after surgery in trialgroup were significantly lower than control group ;the 163.com decrease of creatinine clearance rate of 48 h[SMD=1.27, 95%CI(0.48,2.07),P=0.001] and 72 h[SMD=0.37,95%CI(0.07,0.67),P=0.02] after surgery in trial group were significantly lower than control group ;cystatin C of 24 h[SMD=-0.93,95%CI(-1.72,-0.14),P=0.02],48 h[SMD=-1.72,95%CI (-2.33,-1.10),P<0.000 01] and 72 h[SMD=-0.36,95%CI(-0.62,-0.10),P=0.006] after surgery in trial group were significantly lower than control group. CONCLUSIONS Pretreatment of nicorandil can reduce the incidence of contrast-induced nephropathy in patients underwent CAG or CSI ,and reduce the damage of renal function after application of contrast.
期刊: 2022年第33卷第09期
作者: 马光,程雨佳,滕伟
AUTHORS: MA Guang ,CHENG Yujia,TENG Wei
关键字: 尼可地尔;冠脉造影术;冠脉支架植入术;造影剂肾病;预防
KEYWORDS: nicorandil;coronary angiography ;coronary stent implantation ;contrast-induced nephropathy ;prevention
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