西那卡塞治疗慢性肾脏病透析患者继发性甲状旁腺功能亢进症安全性与有效性的meta分析

发布时间：2018-11-08 13:49

【摘要】：背景及目的西那卡塞是一种新型的治疗慢性肾脏病继发性甲状旁腺功能亢进症的药物,使用meta分析及系统评价综合分析其治疗的安全性与有效性。检索方法在Cochrane Central Register of Controlled Trials,Cochrane Database of Systematic Reviews, Embase, MEDLINE四个数据库中检索应用西那卡塞治疗慢性肾脏病继发甲状旁腺功能亢进症的随机对照试验,试验组接受西那卡塞加常规治疗,对照组接受安慰剂加常规治疗或只接受常规治疗,常规治疗包括维生素D类似物和(或)磷结合剂。结果共检索出14篇满足要求的文献,包括13个随机对照试验,共纳入6896名规律透析的患者。研究发现西那卡塞明显降低了继发性甲状旁腺功能亢进症患者血PTH水平(mean difference,-285.89pg/ml [95%CI-341.27,-230.51])、血钙浓度(mean difference,-0.82mg/dl [95%CI-0.94,-0.70])、血磷浓度(mean difference,-0.39mg/dl [95%CI-0.54,-0.25])以及钙磷乘积的水平(mean difference,-8.99mg2/d12[95%CI-10.37,-7.61]),但是西那卡塞对骨代谢方面作用不确定,也并不能降低患者的全因死亡率(RR0.97[95%CI0.89,1.05])。相较于对照组,使用西那卡塞治疗的患者更容易发生低钙血症(RR,7.34[95%CI5.38,10.03])。恶心(RR,1.83[95%CI1.65,2.03])、呕吐(RR,1.89[95%CI1.68,2.12])、上呼吸道感染(RR,1.51[95%CI1.08,2.10])。结论西那卡塞治疗能有效的改善继发性甲状旁腺功能亢进症患者血生化指标,但并没有有效降低患者的全因死亡率。
[Abstract]:Background and objective Sinakaser is a novel drug for the treatment of secondary hyperparathyroidism in chronic kidney disease. The safety and efficacy of the treatment were analyzed by meta and systematic evaluation. Methods A randomized controlled trial of the treatment of hyperparathyroidism secondary to chronic kidney disease with Sinakaser in four databases of Cochrane Central Register of Controlled Trials,Cochrane Database of Systematic Reviews, Embase, MEDLINE was conducted. The trial group was treated with Sinakaser plus routine therapy. The control group received placebo plus conventional therapy or only conventional therapy, including vitamin D analogue and / or phosphorus binder. Results A total of 14 articles were retrieved, including 13 randomized controlled trials, including 6896 regular dialysis patients. The study found that Sinakaser significantly reduced the serum PTH level (mean difference,-285.89pg/ml [95CI-341.27- 230.51]) and the serum calcium concentration (mean difference,) in patients with secondary hyperparathyroidism. -0.82mg/dl [95: CI-0.94- 0.70], blood phosphorus concentration (mean difference,-0.39mg/dl [95 CI-0.54U -0.25]) and level (mean difference, of calcium and phosphorus product -8.99mg2/d12 [95 CI-10.37 -7.61], but Sinakaser's role in bone metabolism was uncertain and did not reduce the all-cause mortality of patients (RR0.97 [95CI0.891.05]). Patients treated with Sinakaser were more likely to develop hypocalcemia than those in the control group (RR,7.34 [95 CI 5.38 卤10.03]). Nausea (RR,1.83 [95CI 1.65C 2.03], vomiting (RR,1.89 [95CI 1.682.12]), upper respiratory tract infections (RR,1.51 [95CI 1.08m2.10]). Conclusion Sinakaser can effectively improve the blood biochemical indexes of patients with secondary hyperparathyroidism, but it does not effectively reduce the all-cause mortality of patients with hyperparathyroidism.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R692

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