Limited Clinical Utility of Remote Ischemic Conditioning in Renal Transplantation: A Meta-Analysis of Randomized Controlled Trials.
Limited Clinical Utility of Remote Ischemic Conditioning in Renal Transplantation: A Meta-Analysis of Randomized Controlled Trials.
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肾移植中远程缺血调理的临床效用有限：随机对照试验的荟萃分析。
DOI：
10.1371/journal.pone.0170729
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Jia RP
中科院分区：
文献类型：
--
作者：
Zhou CC;Ge YZ;Yao WT;Wu R;Xin H;Lu TZ;Li MH;Song KW;Wang M;Zhu YP;Zhu M;Geng LG;Gao XF;Zhou LH;Zhang SL;Zhu JG;Jia RP
我们进行了随机对照试验(RCT)的荟萃分析，以调查远程缺血调理(RIC)是否能改善肾移植中的移植物功能。在2016年10月5日之前，对PubMed、Web of Science和Cochrane图书馆进行全面搜索，以确定所有符合条件的研究。用危险比(RR)和加权平均差与相应的95%可信区间(CI)检验治疗效果。用Z检验和Q检验评价其统计学意义和异质性。最终确定了总共6个随机对照试验，其中包括651名受助者。与对照组相比，RIC可降低肾移植后移植肾功能延迟恢复(DGF)的发生率(随机效应模型RR=0.89；固定效应模型RR=0.84)。然而，这一下降并未显示出统计意义。按RIC类型进行的亚组分析显示，三种干预措施在保护移植肾抵抗DGF方面没有显著差异。此外，RIC组和对照组在急性排斥反应、移植物丢失、血肌酐下降50%的发生率以及估计的肾小球滤过率和住院时间方面没有显著差异。这一Meta分析提示RIC可能在人肾移植中发挥肾保护作用，进一步设计合理的大样本量RCT以评估其临床疗效是有必要的。
We conducted this meta-analysis of randomized controlled trials (RCTs) to investigate whether remote ischemic conditioning (RIC) could improve graft functions in kidney transplantation. PubMed, Web of Science, and Cochrane Library were comprehensively searched to identify all eligible studies by October 5, 2016. The treatment effects were examined with risk ratio (RR) and weighted mean difference with the corresponding 95% confidence intervals (CI). The statistical significance and heterogeneity were assessed with both Z-test and Q-test. A total of six RCTs including 651 recipients, were eventually identified. Compared to the controls, RIC could reduce the incidence of delayed graft function (DGF) after kidney transplantation (random-effects model: RR = 0.89; fixed-effect model: RR = 0.84). However, the decrease did not reveal statistical significance. The subgroup analysis by RIC type demonstrated no significant difference among the three interventions in protecting renal allografts against DGF. Furthermore, no significant difference could be observed in the incidence of acute rejection, graft loss, 50% fall in serum creatinine, as well as the estimated glomerular filtration rate and hospital stay between the RIC and Control groups. This meta-analysis suggested that RIC might exert renoprotective functions in human kidney transplantation, and further well-designed RCTs with large sample size are warranted to assess its clinical efficacy.