普罗布考预防对比剂肾病的Meta-分析

目的 采用Meta-分析方法评价普罗布考对对比剂肾病的保护作用。方法 计算机检索PubMed、EMbase、Web ofScience、The Cochrane Library、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，检索时间均为建库-2018年11月，收集应用普罗布考预防对比剂肾病的随机对照试验（RCT），评价纳入RCT的偏倚风险，采用RevMan 5和Stata 12软件进行Meta-分析。结果 共纳入14个RCTs，包括3503例患者。Meta-分析结果显示：普罗布考组对比剂肾病的发生率显著低于对照组[OR=0.321，95% CI （0.236~0.437），P=0.000]。术后24 h、48 h、72 h的肌酐水平，普罗布考组均低于对照组[SMD=-0.523，95% CI （-0.957~-0.106），P=0.014]、[SMD=-0.679，95% CI （-0.997~-0.362），P=0.000]、[SMD=-0.461，95% CI （-0.645~-0.277），P=0.000]。亚组分析结果显示：普罗布考组对比剂肾病发生率和血肌酐水平均低于对照组，普罗布考组对比剂肾病发生率和血肌酐水平均低于对照组，而结合仅造影后水化两组的差异无统计学意义；无论患者是否患有糖尿病，普罗布考组对比剂肾病发生率和血肌酐水平均低于对照组。结论 普罗布考结合造影前后水化及仅造影前水化对对比剂肾病有保护作用。受纳入研究数量和质量限制，上述结论仍需开展更多高质量的随机对照试验加以验证。

Meta-analysis of protective effect of probucol on contrast-induced nephropathy

Objective To evaluate the protective effect of probucol on contrast-induced nephropathy using meta-analysis. Methods The databases of PubMed, EMBASE, Web of Science, The Cochrane Library, CNKI, CBM, VIP and WanFang Data were retrieved with computer for collecting the randomized controlled trials (RCT) about the prevention of contrast-induced nephropathy using probucol from the establishment of the databases to November 2018. The included RCTs were screened, extracted and reviewed on bias risk by two reviewers according to inclusion and exclusion criteria,and given Meta-analysis by using RevMan5 and STATA 12 software.Results A totally of 14 RCTs were included,including 3503 patients.The results of Meta-analysis showed that the incidence of CIN was significantly lower in probucol group than that in the control group[OR=0.321, 95%CI(0.236~0.437), P=0.000]. The level of serum creatinine (SCr) at 24 h, 48 h and 72 h were lower in probucol group than that in the control group[SMD=-0.523, 95%CI(-0.957~-0.106), P=0.014],[SMD=-0.679, 95%CI(-0.997~-0.362), P=0.000],[SMD=-0.461, 95%CI(-0.645~-0.277), P=0.000]. Subgroup analysis was carried out on the types of iodine contrast agents and the type of hydration. The results of subgroup analysis showed that the incidence of CIN and the level of SCr were lower in the probucol than those in the control group regardless of the non-ionic isotonic contrast agent or non-ionic low permeability contrast agent. No matter using hydration before and/or after using contrast agent, the incidence of CIN and the level of SCr in the probucol group were lower than those in the control group, while there was no significant difference between the two groups after using iodine contrast agent. Regardless of the patient had diabetes, the incidence of CIN was significantly lower in probucol group than that in the control group, and the level of SCr at 72 h was lower in probucol group than that in the control group. Conclusion Probucol combined with hydration before and after angiography and pre-contrast hydration has a protective effect on contrast nephropathy. Due to limited quantity and quality of the included studies, more high-quality studies were needed to verify above conclusions.