维生素D治疗IgA肾病疗效及安全性的系统评价

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维生素D治疗IgA肾病疗效及安全性的系统评价

宋琼,吴蓉,李建华

兰州大学第一临床医学院,兰州大学第一医院肾病科,兰州大学第一医院肾病科

收稿日期:2017-03-22 修回日期:2017-06-13 出版日期:2017-06-25 发布日期:2017-06-26
基金资助:
无

Systematic Review on Efficacy and Safety of Vitamin D for IgA Nephropathy

The First Clinical Medical College of Lanzhou University,,

Received:2017-03-22 Revised:2017-06-13 Online:2017-06-25 Published:2017-06-26

摘要/Abstract

摘要： 目的系统评价维生素D治疗IgA肾病疗效及安全性。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CBM、CNKI、VIP、WanFang数据库，纳入维生素D治疗IgA肾病疗效及安全性的随机对照试验（RCT），检索时间均为从建库至2016年11月10日。由2位研究员按照纳入与排除标准筛选文献、提取数据和评价文献质量后，采用RevMan 5.3软件进行Meta分析。结果最终共纳入13个RCT，包括674例研究对象。Meta分析结果显示：与阳性对照组（ACEI/ARB）相比，小剂量试验组（≦0.25μg/d）在降低尿蛋白定量［MD = -0.33，95%CI（-0.48，-0.17），P<0.0001］、大剂量试验组（0.5μg/d）在降低尿蛋白定量［MD = -0.52，95%CI（-0.86，-0.17），P=0.003］方面疗效均优于对照组，但不同剂量试验组间降尿蛋白作用差异并无统计学意义；与阳性对照组相比，试验组在升高血钙浓度［MD = 0.05，95%CI（0.01，0.09），P=0.006］、降低超敏C反应蛋白［MD = -2.10，95%CI（-2.35，-1.85），P<0.00001］等方面，其差异均有统计学意义。与空白对照组相比，试验组在尿蛋白定量［MD = -0.32，95%CI（-0.61，-0.03），P=0.03］、血钙［MD =0.18，95%CI（0.07，0.29），P=0.002］、超敏C反应蛋白［MD =-1.20，95%CI（-2.45，0.05），P=0.06］等方面，其差异均有统计学意义。在降低血肌酐水平和不良反应方面，试验组与不同对照组差异无统计学意义（P＞0.05）。结论基于当前的研究证据，与不同对照组相比，试验组在降低尿蛋白、改善炎症状态均有更好的疗效，但相对容易引起血钙浓度升高，需定期监测。

Abstract: Objective The aim of the present study was to investigate the efficacy and safety of vitamin D for treating IgA nephropathy. Methods We searched for randomized controlled trials (RCTs) of vitamin D for the treatment of IgA nephropathy in the PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, VIP and WanFang ,and the retrieval time are from the library to November 10, 2016. The meta-analysis was performed using RevMan 5.3 software after selecting literatures, extracting data and evaluating literature quality according to inclusion and exclusion criteria. Results Our meta-analysis, which included 13 RCTs involving 674 Chinese participants, showed that: compared with ACEI (ARB) group,low dose test group（≦0.25μg/d）in reducing proteinuria (MD = -0.33，95%CI（-0.48，-0.17），P<0.0001)，high dose test group (0.5μg/d) in reducing proteinuria (MD = -0.52，95%CI（-0.86，-0.17），P=0.003), all with significant differences,and there was no significant difference in proteinuria between different dose groups;compared with ACEI (ARB) group, significant differences were observed in serum calcium(MD = 0.05，95%CI（0.01，0.09），P=0.006), hypersensitive C- reactive protein (MD = -2.10，95%CI（-2.35，-1.85），P<0.00001); compared with the blank control group,significant differences were observed in proteinuria (MD = -0.32，95%CI（-0.61，-0.03），P=0.03), serum calcium (MD =0.18，95%CI（0.07，0.29），P=0.002), and hypersensitive C-reactive protein (MD =-1.20，95%CI（-2.45，0.05），P=0.06) levels. No significant differences were observed in serum creatinine and adverse reactions ( p＞0.05).?Conclusion These data indicated that vitamin D is a promising treatment to reduce proteinuria with IgA nephropathy ,but it is relatively easy to cause elevated serum calcium concentration, needed for regular monitoring.

宋琼,吴蓉,李建华. 维生素D治疗IgA肾病疗效及安全性的系统评价[J]. .