Efficacy of short-term high-dose statin in preventing contrast-induced nephropathy: a meta-analysis of seven randomized controlled trials.
Efficacy of short-term high-dose statin in preventing contrast-induced nephropathy: a meta-analysis of seven randomized controlled trials.
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短期大剂量他汀类药物预防造影剂肾病的疗效：七项随机对照试验的荟萃分析
DOI：
10.1371/journal.pone.0034450
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Dai B
中科院分区：
文献类型：
--
作者：
Li Y;Liu Y;Fu L;Mei C;Dai B
一些研究关注他汀类药物治疗作为造影剂肾病的特异性预防措施，已发表了相互矛盾的结果。在这项随机对照试验的荟萃分析中，我们旨在评估短期高剂量他汀类药物治疗预防CIN的有效性和临床结局，并重新评估他汀类药物治疗的潜在获益。我们检索了PubMed、奥维德、EMBASE、Web of science和科克伦对照试验中心数据库，以查找比较短期高剂量他汀类药物治疗与低剂量他汀类药物治疗或安慰剂预防CIN的随机对照试验。我们的结局指标是造影剂给药后2-5天内CIN的风险和透析需求。识别并分析了7项随机对照试验，共1，399例患者。基于固定效应模型的总体结果显示，使用短期高剂量他汀类药物治疗与CIN风险显著降低相关（RR = 0.51，95%CI 0.34-0.76，p = 0.001; I2 = 0%）。 使用他汀类药物后，需要透析的急性肾衰竭的发生率无显著差异（RR = 0.33，95% CI 0.05-2.10，p = 0.24; I2 = 0%）。 他汀类药物的使用与血浆C反应蛋白水平的显著降低无关（SMD −0.64，95% CI：−1.57至0.29，P = 0.18，I2 = 97%）。 尽管该荟萃分析支持使用他汀类药物降低CIN的发生率，但必须在患者人口统计学变量的背景下进行考虑。根据目前的数据，只能提出有限的建议，支持使用他汀类药物。考虑到纳入研究的局限性，需要一项大型、设计良好的试验，纳入对具有不同CIN基础风险的参与者的临床相关结局的评价，以更充分地评估他汀类药物在CIN预防中的作用。
A few studies focused on statin therapy as specific prophylactic measures of contrast-induced nephropathy have been published with conflicting results. In this meta-analysis of randomized controlled trials, we aimed to assess the effectiveness of shor-term high-dose statin treatment for the prevention of CIN and clinical outcomes and re-evaluate of the potential benefits of statin therapy. We searched PubMed, OVID, EMBASE, Web of science and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing short-term high-dose statin treatment versus low-dose statin treatment or placebo for preventing CIN. Our outcome measures were the risk of CIN within 2–5 days after contrast administration and need for dialysis. Seven randomized controlled trials with a total of 1,399 patients were identified and analyzed. The overall results based on fixed-effect model showed that the use of short-term high-dose statin treatment was associated with a significant reduction in risk of CIN (RR = 0.51, 95% CI 0.34–0.76, p = 0.001; I2 = 0%). The incidence of acute renal failure requiring dialysis was not significant different after the use of statin (RR = 0.33, 95% CI 0.05–2.10, p = 0.24; I2 = 0%). The use of statin was not associated with a significant decrease in the plasma C-reactive protein level (SMD −0.64, 95% CI: −1.57 to 0.29, P = 0.18, I2 = 97%). Although this meta-analysis supports the use of statin to reduce the incidence of CIN, it must be considered in the context of variable patient demographics. Only a limited recommendation can be made in favour of the use of statin based on current data. Considering the limitations of included studies, a large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of CIN is required to more adequately assess the role for statin in CIN prevention.
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