司维拉姆治疗透析患者高磷血症的快速评估

摘 要 目的：快速评估司维拉姆治疗透析患者高磷血症的有效性、安全性和经济性。方法：通过计算机检索PubMed、Embase、the Cochrane Library和专业卫生技术评估数据库收集司维拉姆治疗透析患者高磷血症的卫生技术评估报告、系统评价/Meta分析和经济学评价。按照纳入排除标准筛选文献、提取资料和评价质量，对研究结果进行全面分析后得出结论。结果：共纳入22项研究，其中5项卫生技术评估报告、7项系统评价/Meta分析和10项经济学评价。结果显示司维拉姆可有效控制血磷水平，同时不增加血钙水平和高钙血症的风险。此外，和含钙磷结合剂相比，司维拉姆组患者总胆固醇、低密度脂蛋白胆固醇及C反应蛋白水平较低，且司维拉姆治疗并没有过度抑制血清全段甲状旁腺激素水平。国内外的经济学研究显示，与含钙磷结合剂相比，司维拉姆用于透析患者具有成本效果优势。国内的经济学研究显示，与碳酸镧相比，司维拉姆可能更具有成本效果优势，但仍需进一步研究。结论：基于目前可获得的证据支持司维拉姆用于透析患者高磷血症的治疗。

A Rapid Assessment of Sevelamer in Treating Dialysis Patients with Hyperphosphatemia

ABSTRACT Objective:To rapidly assess the efficacy, safety and economics of sevelamer in treating dialysis patients with hyperphosphatemia. Methods:Electronic databases including PubMed, Embase, the Cochrane Library, and relevant health technology assessment databases were systematically searched to collect the health technology assessment reports, systematic reviews/Meta analyses, and economic analyses that evaluate sevelamer in treating dialysis patients with hyperphosphatemia. We selected studies according to inclusion and exclusion criteria, extracted data, assessed the quality, and then made the conclusions after comprehensive analysis of the evidence. Results:22 studies were selected, including 5 health technology assessment reports, 7 systematic reviews/Meta analyses, and 10 economic analyses. The results showed that sevelamer was efficient in controlling serum phosphorus levels, without increasing the serum calcium levels and risk of hypercalcemia. Patients treated with sevelamer had lower total cholesterol, LDL cholesterol, and C reactive protein, and without over inhibition of serum intact parathyroid hormone levels. The results from economic analyses from both China and abroad showed that sevelamer was a cost effective option in treating dialysis patients with hyperphosphatemia, compared with calcium based phosphate binders. In China, sevelamer is likely to be a cost saving option compared to lanthanum, but further studies are still needed.Conclusion:Current available evidence supports use of sevelamer for treating dialysis patients with hyperphosphatemia.