Effect of Theophylline on Prevention of Contrast-Induced Acute Kidney Injury: A Meta-analysis of Randomized Controlled Trials
Effect of Theophylline on Prevention of Contrast-Induced Acute Kidney Injury: A Meta-analysis of Randomized Controlled Trials
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茶碱对预防造影剂引起的急性肾损伤的作用：随机对照试验的荟萃分析
DOI：
10.1053/j.ajkd.2012.02.332
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发表时间：
2012-09-01
影响因子：
13.2
通讯作者：
Mei, Changlin
中科院分区：
文献类型：
--
作者：
Dai, Bing;Liu, Yawei;Mei, Changlin
背景：使用腺苷受体拮抗剂如茶碱是否可以预防造影剂诱导的急性肾损伤(AKI)仍然存在争议。研究设计：我们使用MEDLINE(1966-2011年7月)、EMBASE(1980-2011年7月)、Web of Science(1986-2011年7月)和Cochrane中央对照试验(1996-2011年7月)对随机对照试验进行了荟萃分析。无语言限制。背景与人群：接受造影剂治疗的患者。研究选择标准：评价腺苷拮抗剂与对照组预防造影剂诱导急性脑梗塞的随机对照试验。干预：腺苷拮抗剂加或不加N-乙酰半胱氨酸与对照组加或不加N-乙酰半胱氨酸。结果：造影剂诱导急性心肌梗死、血清肌酐水平变化、透析需求和住院死亡率。结果：纳入16项试验(1412名参与者)。茶碱显著降低了造影剂诱发急性心肌梗死的风险(13个试验，1,222名患者；风险比，0.48；95%CI，0.26-0.89；P=0.02；I-2=45%)，并对血清肌酐浓度的绝对变化有保护作用(13个试验，1,170名患者；标准化平均差，-0.31 mg/dL；95%CI，-0.50至-0.11；P=0.002；I-2=60%)。Meta回归分析显示，造影剂肾病的相对风险与基线血肌酐水平或Jadad评分显著相关。没有明确的治疗对透析风险和住院死亡率的影响。限制：评估临床终点的能力有限。结论：茶碱治疗显著降低了造影剂诱导的AKI的发生率，在普通人群中造影剂暴露后对肾功能有适度的改善。然而，在基线肌酸值较高的患者(血肌酐和Gt；=1.5 mg/dL)中，茶碱并未观察到有益效果。此外，这种药物对临床上更重要的结果的长期影响还没有确定。未来需要在具有不同造影剂诱发AKI潜在风险的参与者中进行大规模高质量的多中心试验，并纳入临床相关结果的评估。我是J·肯尼·迪斯。60(3)：360-370。(C)2012年，由国家肾脏基金会公司提供。
Background: Whether treatment with adenosine receptor antagonists such as theophylline can prevent contrast-induced acute kidney injury (AKI) remains controversial.Study Design: We conducted a meta-analysis of randomized controlled trials using MEDLINE (1966 to July 2011), EMBASE (1980 to July 2011), Web of Science (1986 to July 2011), and the Cochrane Central Register of Controlled Trials (1996 to July 2011), without language restriction.Setting & Population: Patients undergoing contrast procedures.Selection Criteria for Studies: Randomized controlled trials assessing adenosine antagonists versus control for prevention of contrast-induced AKI.Intervention: Adenosine antagonists with or without N-acetylcysteine versus control with or without N-acetylcysteine.Outcomes: Contrast-induced AKI, change in serum creatinine level, requirement of dialysis, and in-hospital mortality.Results: 16 trials (1,412 participants) were included. Theophylline significantly decreased the risk of contrast-induced AKI (13 trials, 1,222 patients; risk ratio, 0.48; 95% CI, 0.26-0.89; P = 0.02; I-2 = 45%) and had a protective effect on the absolute change in serum creatinine concentration (13 trials, 1,170 patients; standardized mean difference, -0.31 mg/dL; 95% CI, -0.50 to -0.11; P = 0.002; I-2 = 60%). Meta-regression showed a significant relation between the relative risk of contrast nephropathy and baseline serum creatinine level or Jadad score. No clear effects of treatment on risk of dialysis and in-hospital mortality were identified.Limitations: Power to assess clinical end points was limited.Conclusions: Theophylline treatment significantly reduced the incidence of contrast-induced AKI and had a modest improvement on kidney function after contrast exposure in the general population. However, beneficial effects of theophylline were not observed in patients with high baseline creatinine values (serum creatinine >= 1.5 mg/dL). In addition, the long-term effect of this agent on more clinically important outcomes was not established. Future large-scale high-quality multicenter trials in participants with different underlying risks of contrast-induced AKI and that incorporate the evaluation of clinically relevant outcomes are required. Am J Kidney Dis. 60(3): 360-370. (C) 2012 by the National Kidney Foundation, Inc.