维生素D及其类似物在慢性肾脏病非透析患者中的肾脏保护作用的荟萃分析

目的 探讨维生素D及其类似物在慢性肾脏病(chronic kidney disease, CKD)非透析患者中的肾脏保护作用。方法 按照文献检索策略对PubMed、Embase、中国知网 (CNKI)、中国生物医学文献数据库(CBM)等进行文献检索,纳入有关维生素D及其类似物对CKD患者蛋白尿及疾病进展作用的随机对照研究,并根据纳排标准对文献进行筛选,通过Revman 5.4软件对最终纳入文献的数据进行荟萃分析。结果 共纳入7篇文献,共616名患者。与对照组相比,应用维生素D及其类似物可降低CKD患者尿蛋白/肌酐比值(SMD=-0.30,P=0.001;95%CI:-0.48~-0.12),减少24 h尿蛋白(SMD=-0.67,P=0.01;95%CI:-1.19~-0.14),还可以降低CKD患者血清甲状旁腺激素水平(PTH)(SMD=-33.53, P=0.008;95%CI:-58.48~-8.58),升高血钙(SMD=0.11,P=0.04;95%CI:0.01~0.21)、降低血磷(SMD=-0.01, P=0.04;95%CI:0.01~0.21)。但是,未观察到维生素D对血肌酐(SMD=-9.41,P=0.38;95%CI:-30.27~11.46)及估算的肾小球滤过率(eGFR)(SMD=0.94, P=0.67;95%CI:-3.35~5.22)的积极作用。结论 维生素D及其类似物可以降低CKD非透析患者24 h蛋白尿水平及尿蛋白/肌酐比值,提高患者血钙水平、降低PTH水平、抑制继发性甲状旁腺功能亢进的发生发展。但是,没有循证医学证据支持其降低患者血肌酐、改善肾功能的作用。

A meta-analysis of the renal protective effects of vitamin D and its analogues in non dialysis patients with chronic kidney disease

Objective To investigate the renal protective effect of vitamin D and its analogs in non-dialysis patients with chronic kidney disease (CKD). Methods PubMed, Embase, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), etc. were searched according to the literature search strategy, and randomized controlled studies regarding the effects of vitamin D and its analogs on proteinuria and disease progression in CKD patients were included. Controlled studies were conducted, and the literature was screened according to the inclusion and exclusion criteria, the data of the included literature was meta-analyzed by Revman 5.4 software. Results A total of 7 articles with 616 patients were included.Compared with the control group, the vitamin D and its analogs reduced the ratio of urine protein/creatinine in CKD patients (SMD=-0.30, P=0.001; 95%CI:-0.48 to -0.12), decreased 24-hour urine protein (SMD=-0.67, P=0.01; 95%CI: -1.19 to -0.14), meantime, reduce serum parathyroid hormone (PTH) (SMD=-33.53, P=0.008; 95%CI: -58.48 to -8.58), increase serum calcium (SMD=0.11, P=0.04; 95%CI: 0.01 to 0.21), decreased blood phosphorus (SMD=-0.01, P=0.04; 95%CI: 0.01 to 0.21). However, the positive effect of vitamin D on serum creatinine (SMD=-9.41, P=0.38; 95%CI: -30.27 to 11.46) and estimated glomerular filtration rate ( eGFR ) (SMD=0.94, P=0.67; 95%CI: -3.35 to 5.22) was not observed. Conclusion Vitamin D and its analogs can reduce 24-hour proteinuria and urine protein/creatinine ratio in non-dialysis patients with CKD, also increase blood calcium level, reduce PTH, and inhibit the occurrence and development of secondary hyperparathyroidism. However, there is no evidence-based medical evidence to support the roles in reducing serum creatinine and improving renal function in CKD patients.