碳酸镧联用醋酸钙或碳酸钙治疗血液透析患者高磷血症的Meta分析

目的 系统评价碳酸镧联用醋酸钙或碳酸钙治疗血液透析患者高磷血症的有效性和安全性。方法 计算机检索PubMed、Embase、Cochrane图书馆，中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普中文期刊全文数据库（VIP）和万方数据库，纳入碳酸镧联用醋酸钙或碳酸钙治疗血液透析患者高磷血症的临床随机对照试验（RCT），检索时限均为建库起至2020年10月，筛选文献并进行质量评价后，采用RevMan 5.3软件进行Meta分析。结果 共纳入12项RCTs，1 066例患者。Meta分析结果显示：（1）相对于醋酸钙或碳酸钙单用，碳酸镧联用醋酸钙或碳酸钙显著提高临床有效率[RR=1.32，95% CI=（1.22，1.42），P<0.01]、降低血磷水平[MD=-0.35，95% CI=（-0.44，-0.27），P<0.01]、血钙水平[MD=-0.17，95% CI=（-0.23，-0.11），P<0.01]和免疫反应性甲状旁腺激素水平[MD=-50.44，95% CI=（-69.71，-31.16），P<0.01]，未显著增加不良反应发生率[RR=0.96，95% CI=（0.62，1.50），P=0.87]；（2）相对于碳酸镧单用，碳酸镧联用醋酸钙或碳酸钙显著提高临床有效率[RR=1.26，95% CI=（1.09，1.45），P<0.01]，降低血磷水平[MD=-0.24，95% CI=（-0.31，-0.17），P<0.01]、免疫反应性甲状旁腺激素水平[MD=-30.09，95% CI=（-52.76，-7.43），P<0.01]，未增加血钙水平[MD=0.09，95% CI=（-0.04，0.23），P=0.18]和不良反应发生率[RR=1.03，95% CI=（0.46，2.33），P=0.94]。结论 碳酸镧联用醋酸钙或碳酸钙治疗血液透析患者高磷血症的临床疗效优于醋酸钙或碳酸钙单用和碳酸镧单用，且未显著增加不良反应发生率。

Meta-analysis of clinical efficacy and safety of lanthanum carbonate combined with calcium acetate or calcium carbonate in treatment of hemodialysis patients with hyperphosphatemia

Objective To systematically evaluate the efficacy and safety of lanthanum carbonate combined with calcium acetate or calcium carbonate in the treatment of hyperphosphatemia patients with hemodialysis. Methods Computer retrieval was conducted in PubMed, Cochrane Library, Medline, CNKI, CMB, VIP and Wanfang database and randomized controlled trials (RCT) about lanthanum carbonate combined with calcium acetate or calcium carbonate in the treatment of hyperphosphatemia patients with hemodialysis from the establishment of the database to October 2020. Meta-analysis was performed using ReVMan 5.3 software after literature screening and quality assessment. Results A total of 12 RCTs involving 1 066 patients were included totally. Metaanalysis results showed that:(1) Compared with single using of calcium acetate or calcium carbonate, lanthanum carbonate combined with calcium acetate or calcium carbonate could significantly improve the clinical effective rate[RR=1.32, 95%CI= (1.22 to 1.42), P < 0.01], reduce blood phosphorus levels[MD=-0.35, 95%CI=(-0.44 to -0.27), P < 0.01], blood calcium Level[MD=0.17, 95%CI=(0.23 to 0.11), P < 0.01], and immunoreactive parathyroid hormone (iPTH) level[MD=47.98, 95%CI=(-65.62 to -30.34), P < 0.01], did not significantly increase the incidence of ADR[RR=0.96, 95%CI=(0.62 to 1.50), P =0.87]; (2) compared with single use of lanthanum carbonate, lanthanum carbonate combined with calcium acetate or calcium carbonate could significantly improve the clinical effective rate[RR=1.26, 95%CI=(1.09 to 1.45), P < 0.01], reduce blood phosphorus levels[MD=-0.24, 95%CI=(-0.31 to -0.17), P < 0.01] and iPTH lever[MD=-30.09, 95%CI=(-52.76 to -7.43), P < 0.01], and no increasing blood calcium level[MD=0.09, 95%CI=(-0.04 to 0.23, P =0.18] and the incidence of ADR[RR=1.03, 95%CI=(0.46 to 2.33), P =0.94]. Conclusion The clinical efficacy of lanthanum carbonate combined with calcium acetate or calcium carbonate in the treatment of hyperphosphatemia patients with hemodialysis is better than that of calcium acetate or calcium carbonate alone and lanthanum carbonate alone, and does not significantly increase the incidence of adverse reactions.