碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症的Meta分析

目的 评价碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症的疗效和安全性.方法 计算机检索MEDLINE(1996-2012.12)、EBCO (1996-2012.12)、Cochrane图书馆临床对照试验资料库和中文万方数据库(1996-2012.12).手工检索已发表或未发表的相关文献,包括会议摘要等.检索无语种限制.纳入碳酸镧与传统磷结合剂比较治疗维持性血液透析患者高磷血症的随机对照试验.由两名评价员独立评价纳入研究的质量和提取资料,并用RevMan 5.0软件进行Meta分析.结果 共纳入10项研究.Meta分析结果显示,碳酸镧与传统磷结合剂相比,降低血磷水平的疗效差异无统计学意义[WMD=-0.06,95％ CI(-0.27～0.15),P=0.57],但碳酸镧治疗组血钙水平低于含钙磷结合剂,两组间因不良反应退出情况差异无统计学意义,碳酸镧治疗组高钙血症发生率低于传统磷结合剂.结论 碳酸镧治疗对终末期肾脏疾病维持性血液透析患者高磷血症有效,且其高钙血症发生率低于传统磷结合剂.

Lanthanum carbonate vs conventional phosphate binders for the treatment of hyperphosphatemia in maintenance hemodialysis patients: a meta-analysis

Objective To assess the effect and safety of lanthanum carbonate vs conventional phosphate binders for hyperphosphatemia in patients undergoing maintenance hemodialysis. Methods According to the collaborative search strategy, MEDLINE (1996 to 2012.12), EBCO (1996 to 2012.12)，the clinical control test database of Cochrane Library and Chinese Wanfang database (1996 to 2012.12) were searched. Related literature, whether Published or not and meeting summary included, were searched by hand. Quality assessment and data extraction were conducted by two independent investigators. Meta - analysis was conducted by RevMan 5.0. The following outcomes were assessed: serum phosphorus levels, serum iPTH levels, serum calcium levels and adverse events. Results were expressed as OR with 95% confidence interval for dichotomous outcomes and WMD with 95% confidence interval for continuous outcomes. Results A total of 10 reports were identified which met the inclusion criteria. The meta-analysis showed that the efficacy of treating hyperparathyroidism in hemodialysis patients was similar between lanthanum carbonate and conventional phosphate binders (WMD＝-0.06, 95% CI-0.27 to 0.15, P＝0.57) and the incidences of discontinuing due to adverse events were also similar. However, there were fewer hypercalcemic episodes and lower serum calcium levels in the lanthanum carbonate group compared to calcium-based phosphorus binders group. Conclusion Lanthanum carbonate is effective and well tolerated in treating hyperphosphatemia in hemodialysis patients with fewer hypercalcemia and lower serum calcium levels compared to calcium- based phosphate binders.