考来替兰对透析患者高磷血症的影响：荟萃分析

发布时间：2018-06-07 18:35

  本文选题：考来替兰 + 透析　； 参考：《吉林大学》2017年硕士论文

【摘要】：背景:高磷血症是终末期肾病的常见并发症。升高的血磷促进继发性甲状旁腺功能亢进、肾性骨营养不良和转移性钙化的发展。流行病学研究已经证明高磷血症和终末期肾病患者增加的死亡率之间的显着关联。目前用于治疗透析患者高磷血症的临床方法包括:(1)限制饮食磷摄入;(2)通过每周三次或更长时间的透析去除磷酸盐;(3)通过应用结合剂降低肠道磷酸盐吸收。常规磷酸盐结合剂的功效是不可靠的,并且它们与一系列副作用相关。含铝的结合剂是高效的,但由于证明存在神经学、骨骼和血液学毒性,不再广泛应用。含镁的结合剂易引起胃肠道不耐受。含钙的结合剂传统上被用作一线治疗,因为它们除了降低血磷水平之外还校正低钙血症,并且价格便宜。然而,由于剂量限制性高钙血症和血管钙化,这些药物可能不适合所有患者。司维拉姆是第一个被批准使用的不含钙、无铝的药物,但其临床应用受到大药丸负荷、代谢性酸中毒、胃肠道紊乱和高成本的限制;镧也是如此。考来替兰,一种不可吸收的非金属阴离子交换树脂,传统上被用作降脂药。然而,最近的研究热点是其作为磷结合剂的潜在用途。目的:为了评价考来替兰作为透析患者磷结合剂的有效性和安全性,进行了随机对照试验的荟萃分析。方法:我们从Medline、EMBASE、Cochrane图书馆、中国生物医学文献数据库、中国学术期刊全文数据库、维普中文科技期刊全文数据库中检索比较透析患者治疗中使用考来替兰与安慰剂的随机对照试验。检索时间均从建库至2016年12月,所有语言的研究包括在内,无论出版状态如何。两位研究者按纳入排除标准筛选文献并评价纳入研究方法学质量。以血磷、血钙、钙磷乘积、甲状旁腺激素、低密度胆固醇水平为评价指标,应用Rev Man5.3软件进行meta分析,使用加权平均差(WMD)及其95%可信区间评价指标。结果:共搜集到5篇文献,包括1282名透析患者。治疗持续时间为2至12周,中位数为7.5周。与安慰剂组相比,考来替兰组患者血磷水平显著降低(WMD,-0.19 mmol/L;95%CI,-0.30至-0.08,P=0.001)、钙磷乘积显著降低(WMD,-0.72mmol/L2;95%CI,-1.05至-0.34,P=0.0001),甲状旁腺激素显著降低(WMD,-5.35pmol/L;95%CI,-8.36至-2.35,P=0.0005)、低密度胆固醇显著降低(WMD,-0.75mmol/L;95%CI,-0.84至-0.70,P0.00001)。血钙水平两组之间中无显著差异。考来替兰组胃肠道疾病显著增加(WMD,3.45mmol/L;95%CI,2.20至5.37,P0.00001)。结论:与安慰剂组相比,考来替兰组患者血磷、钙磷乘积、甲状旁腺激素、低密度胆固醇水平显著降低。血钙水平两组之间中无显著差异。考来替兰组胃肠道疾病显著增加。目前的研究表明短期使用考来替兰能有效治疗高磷血症,但研究的样本量相对较小,随访时间短,未来需要具有更长持续时间的较大样品研究来评估考来替兰的长期功效。
[Abstract]:Background: hyperphosphatemia is a common complication of end-stage nephropathy. Elevated blood phosphorus promotes the development of secondary hyperparathyroidism, renal bone dystrophy and metastatic calcification. Epidemiological studies have shown a significant association between hyperphosphatemia and increased mortality in patients with end-stage nephropathy. Current clinical methods for treatment of hyperphosphatemia in dialysis patients include: 1) limiting dietary phosphorus intake 2) removing phosphate by dialysis three times a week or longer) reducing intestinal phosphate absorption through the use of binders. The efficacy of conventional phosphate binders is unreliable, and they are associated with a range of side effects. Aluminum-containing binders are highly efficient, but are no longer widely used because of proven neurotoxicity, bone and hematological toxicity. Magnesium-containing binders are susceptible to gastrointestinal intolerance. Calcium-containing binders have traditionally been used as first-line treatments because they correct hypocalcemia in addition to reducing blood phosphorus levels and are cheap. However, due to dose-limited hypercalcemia and vascular calcification, these drugs may not be suitable for all patients. Sveram was the first approved calcium-free aluminum-free drug but its clinical use was limited by large pill loads metabolic acidosis gastrointestinal disorders and high costs; so did lanthanum. Cooletylam, an inabsorbable non-metallic anion exchange resin, has traditionally been used as a lipid-lowering drug. However, recent research has focused on its potential use as a phosphorous binder. Objective: to evaluate the efficacy and safety of coletiran as a phosphorus binding agent in dialysis patients, a meta-analysis of randomized controlled trials was conducted. Methods: EMBASE Cochrane Library, Chinese Biomedical Literature Database, full text Database of Chinese academic Journals, A randomized controlled trial of Corletiran and placebo in the treatment of dialysis patients was searched in the full text database of Weip Chinese Journal of Science and Technology. The retrieval time is from the construction of the database to December 2016, and all language studies are included, regardless of publication status. The two researchers screened the literature according to the inclusion exclusion criteria and evaluated the quality of the inclusion methodology. The serum phosphorus, calcium, calcium and phosphorus product, parathyroid hormone and low density cholesterol were used as the evaluation indexes. The meta analysis was carried out by using the software Rev Man5.3, and the weighted average difference (WMD) and its 95% confidence interval were used to evaluate the index. Results: a total of 5 articles were collected, including 1282 dialysis patients. The duration of treatment ranged from 2 to 12 weeks, with a median of 7.5 weeks. 涓庡畨鎱板墏缁勭浉姣，

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