Meta-analysis of randomized trials for medical prevention of calcium oxalate nephrolithiasis
Meta-analysis of randomized trials for medical prevention of calcium oxalate nephrolithiasis
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DOI：
10.1089/end.1999.13.679
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发表时间：
1999-11-01
影响因子：
2.7
通讯作者：
Pak, CYC
中科院分区：
文献类型：
--
作者：
Pearle, MS;Roehrborn, CG;Pak, CYC
目的：为了确定常用药物与安慰剂或无治疗相比在预防肾结石复发（预防性速发型超敏反应）方面的疗效，如文献所述，方法：MEDLINE检索确定了14项随机对照试验，包括20个治疗组和6种不同的预防结石复发的药物治疗。将每项试验的活性治疗组合并，并将结果与对照组或无治疗组的总体结果以及每种药物治疗进行比较（噻嗪类利尿剂、别嘌呤醇、磷酸盐、镁和碱金属柠檬酸盐），对所有试验的联合治疗组和对照组进行荟萃分析，并提供足够的数据，用于整体药物治疗和噻嗪类药物治疗。结果：药物治疗对结石性过敏反应的获益具有统计学意义（P = 0.04），主要是因为与安慰剂或无治疗相比，噻嗪类药物的益处（P = 0.02），别嘌呤醇赋予没有整体效益，虽然唯一的试验评估治疗高尿酸血症patients.Conclusion：药物治疗钙结石疾病的复发率降低治疗显示了统计学显着的好处。虽然药物治疗中只有噻嗪类利尿剂可显著降低结石复发，但研究设计和研究人群的变异性排除了对其他药物治疗（如碱金属柠檬酸盐）的充分分析。研究设计和报告的标准化应改善对新药治疗效果的评价。
Objectives: To determine the efficacy of commonly used medications in comparison with placebo or no treatment for the prevention of renal stone recurrence (metaphylaxis) as documented in the literature,Methods: A MEDLINE search identified 14 randomized, controlled trials comprising 20 treatment arms and 6 different drug therapies for the prevention of stone recurrence. The active treatment arms from each of the trials were combined, and the results were compared with those of the control or no treatment arms overall and for each category of drug therapy (thiazide diuretics, allopurinol, phosphate, magnesium, and alkali citrate), A meta-analysis was performed of the combined treatment and control arms for all trials from which sufficient data were provided, both for overall medical therapy and for thiazide treatment.Results: A statistically significant benefit of drug therapy for stone metaphylaxis was identified (P = 0,04), largely because of the benefit of thiazides compared with placebo or no treatment (P = 0.02), Allopurinol conferred no overall benefit, although the only trial evaluating therapy in hyperuricosuric patients showed a statistically significant benefit.Conclusion: Medical therapy for calcium stone disease reduces the incidence of recurrence. Although only thiazide diuretics among the drug therapies were shown to significantly reduce stone recurrence, variability in study design and study population precluded adequate analysis of other drug therapies such as alkali citrate. Standardization of study design and reporting should improve the evaluation of the efficacy of new drug treatments.