本文選題：考來(lái)替蘭 + 透析　； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：背景:高磷血癥是終末期腎病的常見(jiàn)并發(fā)癥。升高的血磷促進(jìn)繼發(fā)性甲狀旁腺功能亢進(jìn)、腎性骨營(yíng)養(yǎng)不良和轉(zhuǎn)移性鈣化的發(fā)展。流行病學(xué)研究已經(jīng)證明高磷血癥和終末期腎病患者增加的死亡率之間的顯著關(guān)聯(lián)。目前用于治療透析患者高磷血癥的臨床方法包括:(1)限制飲食磷攝入;(2)通過(guò)每周三次或更長(zhǎng)時(shí)間的透析去除磷酸鹽;(3)通過(guò)應(yīng)用結(jié)合劑降低腸道磷酸鹽吸收。常規(guī)磷酸鹽結(jié)合劑的功效是不可靠的,并且它們與一系列副作用相關(guān)。含鋁的結(jié)合劑是高效的,但由于證明存在神經(jīng)學(xué)、骨骼和血液學(xué)毒性,不再?gòu)V泛應(yīng)用。含鎂的結(jié)合劑易引起胃腸道不耐受。含鈣的結(jié)合劑傳統(tǒng)上被用作一線治療,因?yàn)樗鼈兂私档脱姿街膺�校正低鈣血癥,并且價(jià)格便宜。然而,由于劑量限制性高鈣血癥和血管鈣化,這些藥物可能不適合所有患者。司維拉姆是第一個(gè)被批準(zhǔn)使用的不含鈣、無(wú)鋁的藥物,但其臨床應(yīng)用受到大藥丸負(fù)荷、代謝性酸中毒、胃腸道紊亂和高成本的限制;鑭也是如此�？紒�(lái)替蘭,一種不可吸收的非金屬陰離子交換樹(shù)脂,傳統(tǒng)上被用作降脂藥。然而,最近的研究熱點(diǎn)是其作為磷結(jié)合劑的潛在用途。目的:為了評(píng)價(jià)考來(lái)替蘭作為透析患者磷結(jié)合劑的有效性和安全性,進(jìn)行了隨機(jī)對(duì)照試驗(yàn)的薈萃分析。方法:我們從Medline、EMBASE、Cochrane圖書(shū)館、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)、中國(guó)學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)、維普中文科技期刊全文數(shù)據(jù)庫(kù)中檢索比較透析患者治療中使用考來(lái)替蘭與安慰劑的隨機(jī)對(duì)照試驗(yàn)。檢索時(shí)間均從建庫(kù)至2016年12月,所有語(yǔ)言的研究包括在內(nèi),無(wú)論出版狀態(tài)如何。兩位研究者按納入排除標(biāo)準(zhǔn)篩選文獻(xiàn)并評(píng)價(jià)納入研究方法學(xué)質(zhì)量。以血磷、血鈣、鈣磷乘積、甲狀旁腺激素、低密度膽固醇水平為評(píng)價(jià)指標(biāo),應(yīng)用Rev Man5.3軟件進(jìn)行meta分析,使用加權(quán)平均差(WMD)及其95%可信區(qū)間評(píng)價(jià)指標(biāo)。結(jié)果:共搜集到5篇文獻(xiàn),包括1282名透析患者。治療持續(xù)時(shí)間為2至12周,中位數(shù)為7.5周。與安慰劑組相比,考來(lái)替蘭組患者血磷水平顯著降低(WMD,-0.19 mmol/L;95%CI,-0.30至-0.08,P=0.001)、鈣磷乘積顯著降低(WMD,-0.72mmol/L2;95%CI,-1.05至-0.34,P=0.0001),甲狀旁腺激素顯著降低(WMD,-5.35pmol/L;95%CI,-8.36至-2.35,P=0.0005)、低密度膽固醇顯著降低(WMD,-0.75mmol/L;95%CI,-0.84至-0.70,P0.00001)。血鈣水平兩組之間中無(wú)顯著差異�？紒�(lái)替蘭組胃腸道疾病顯著增加(WMD,3.45mmol/L;95%CI,2.20至5.37,P0.00001)。結(jié)論:與安慰劑組相比,考來(lái)替蘭組患者血磷、鈣磷乘積、甲狀旁腺激素、低密度膽固醇水平顯著降低。血鈣水平兩組之間中無(wú)顯著差異�？紒�(lái)替蘭組胃腸道疾病顯著增加。目前的研究表明短期使用考來(lái)替蘭能有效治療高磷血癥,但研究的樣本量相對(duì)較小,隨訪時(shí)間短,未來(lái)需要具有更長(zhǎng)持續(xù)時(shí)間的較大樣品研究來(lái)評(píng)估考來(lái)替蘭的長(zhǎng)期功效。
[Abstract]:Background: hyperphosphatemia is a common complication of end-stage nephropathy. Elevated blood phosphorus promotes the development of secondary hyperparathyroidism, renal bone dystrophy and metastatic calcification. Epidemiological studies have shown a significant association between hyperphosphatemia and increased mortality in patients with end-stage nephropathy. Current clinical methods for treatment of hyperphosphatemia in dialysis patients include: 1) limiting dietary phosphorus intake 2) removing phosphate by dialysis three times a week or longer) reducing intestinal phosphate absorption through the use of binders. The efficacy of conventional phosphate binders is unreliable, and they are associated with a range of side effects. Aluminum-containing binders are highly efficient, but are no longer widely used because of proven neurotoxicity, bone and hematological toxicity. Magnesium-containing binders are susceptible to gastrointestinal intolerance. Calcium-containing binders have traditionally been used as first-line treatments because they correct hypocalcemia in addition to reducing blood phosphorus levels and are cheap. However, due to dose-limited hypercalcemia and vascular calcification, these drugs may not be suitable for all patients. Sveram was the first approved calcium-free aluminum-free drug but its clinical use was limited by large pill loads metabolic acidosis gastrointestinal disorders and high costs; so did lanthanum. Cooletylam, an inabsorbable non-metallic anion exchange resin, has traditionally been used as a lipid-lowering drug. However, recent research has focused on its potential use as a phosphorous binder. Objective: to evaluate the efficacy and safety of coletiran as a phosphorus binding agent in dialysis patients, a meta-analysis of randomized controlled trials was conducted. Methods: EMBASE Cochrane Library, Chinese Biomedical Literature Database, full text Database of Chinese academic Journals, A randomized controlled trial of Corletiran and placebo in the treatment of dialysis patients was searched in the full text database of Weip Chinese Journal of Science and Technology. The retrieval time is from the construction of the database to December 2016, and all language studies are included, regardless of publication status. The two researchers screened the literature according to the inclusion exclusion criteria and evaluated the quality of the inclusion methodology. The serum phosphorus, calcium, calcium and phosphorus product, parathyroid hormone and low density cholesterol were used as the evaluation indexes. The meta analysis was carried out by using the software Rev Man5.3, and the weighted average difference (WMD) and its 95% confidence interval were used to evaluate the index. Results: a total of 5 articles were collected, including 1282 dialysis patients. The duration of treatment ranged from 2 to 12 weeks, with a median of 7.5 weeks. 涓庡畨鎱板墏緇勭浉姣，

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