本文選題：高磷血癥 + 磷結(jié)合劑��； 參考：《浙江大學(xué)》2014年博士論文

【摘要】：目的：高磷血癥是慢性腎臟病常見的并發(fā)癥。長期的高磷血癥可導(dǎo)致繼發(fā)性甲狀旁腺功能亢進、腎性骨病、血管鈣化等,增加ESRD患者全因住院率、心血管事件及全因死亡率。因此有效控制血磷對改善ESRD患者預(yù)后具有重要意義。目前臨床上常用的磷結(jié)合劑主要分為含鈣磷結(jié)合劑(碳酸鈣、醋酸鈣)和非含鈣非含鋁磷結(jié)合劑(碳酸鑭、司維拉姆)兩大類。本研究的主要目的是對碳酸鈣、醋酸鈣、碳酸鑭、司維拉姆及安慰劑這四大類藥物治療終末期腎臟病維持性血液透析患者高磷血癥的有效性和安全性進行系統(tǒng)評價。 方法：利用計算機檢索Pubmed, ISI Web of Science, Cochrane圖書館臨床對照試驗數(shù)據(jù)庫,同時通過手工檢索相關(guān)系統(tǒng)評價的參考文獻作為補充。檢索日期為自建庫至2013年12月30日。檢索已公開發(fā)表的隨機對照研究。研究的干預(yù)與對照分別為四種降磷藥物(碳酸鈣、醋酸鈣、碳酸鑭、司維拉姆)和安慰劑中的一種。觀測的結(jié)局指標包括：血磷水平、血鈣水平、血鈣磷乘積、血IPTH、高鈣血癥的發(fā)生率。應(yīng)用R2WinBUGS軟件進行貝葉斯網(wǎng)絡(luò)Meta分析及藥效排序。 結(jié)果：共納入25個研究,包括3111例患者。其中碳酸鈣與醋酸鈣比較的文獻3篇,司維拉姆與醋酸鈣比較的文獻6篇,司維拉姆與碳酸鈣比較的文獻7篇,司維拉姆與碳酸鑭比較的文獻1篇,司維拉姆與安慰劑比較的文獻1篇,碳酸鑭與安慰劑比較的文獻4篇,碳酸鑭與碳酸鈣比較的文獻4篇。貝葉斯網(wǎng)絡(luò)Meta分析結(jié)果顯示：對于維持性血透病人,碳酸鑭、司維拉姆、碳酸鈣、醋酸鈣四類藥物在降磷幅度、血鈣磷乘積、血IPTH水平上兩兩比較均沒有顯著差異,且顯著優(yōu)于安慰劑；碳酸鑭、司維拉姆對血鈣的影響與安慰劑比較均無顯著差異,且顯著低于碳酸鈣、醋酸鈣；碳酸鑭治療組、司維拉姆治療組高鈣血癥的發(fā)生率顯著低于碳酸鈣、醋酸鈣；目前還沒有足夠多的證據(jù)針對血透患者住院率、血管鈣化、骨病、死亡率等終點事件進行網(wǎng)絡(luò)Meta分析。 結(jié)論：非含鈣磷結(jié)合劑(碳酸鑭、司維拉姆)能有效、安全的用于治療維持性血透病人的高磷血癥。與含鈣磷結(jié)合劑相比,碳酸鑭和司維拉姆對血鈣的影響較小,能減少血透患者高鈣血癥的發(fā)生率。目前仍需大樣本、多中心的高質(zhì)量研究,為碳酸鈣、醋酸鈣、司維拉姆、碳酸鑭這四類藥物對患者全因住院率、心血管事件、全因死亡率等終點提供進一步證據(jù)。
[Abstract]:Objective: hyperphosphatemia is a common complication of chronic kidney disease.Long-term hyperphosphatemia can lead to secondary hyperparathyroidism, renal osteopathy, vascular calcification and so on.Therefore, the effective control of blood phosphorus is of great significance in improving the prognosis of patients with ESRD.At present, the commonly used phosphate binders are mainly classified into two categories: calcium carbonate (calcium carbonate, calcium acetate) and non-calcium (lanthanum carbonate, Sveram).The aim of this study was to evaluate the efficacy and safety of calcium carbonate, calcium acetate, lanthanum carbonate, sparviram and placebo in the treatment of hyperphosphatemia in maintenance hemodialysis patients with end-stage renal disease.Methods: Pubmed, ISI Web of Science, Cochrane library clinical controlled trial databases were searched by computer, and the related systematic evaluation references were manually searched as supplement.The retrieval date is from self-built library to December 30, 2013.Search for published randomized controlled studies.The intervention was one of four phosphorus lowering drugs (calcium carbonate, calcium acetate, lanthanum carbonate, Sveram) and placebo.The outcome indicators included: serum phosphorus level, serum calcium level, serum calcium and phosphorus product, serum IPTHs, incidence of hypercalcemia.Bayesian network Meta analysis and pharmacodynamics ordering were carried out with R2WinBUGS software.Results: a total of 25 studies, including 3111 patients, were included.Among them, there were 3 articles comparing calcium carbonate with calcium acetate, 6 articles comparing Sveram with calcium acetate, 7 articles comparing Sveram with calcium carbonate, and one article comparing Sveram with lanthanum carbonate.There were 1 literature comparing Sveram with placebo, 4 articles comparing lanthanum carbonate with placebo, 4 articles comparing lanthanum carbonate with calcium carbonate.The results of Bayesian network Meta analysis showed that for maintenance hemodialysis patients, lanthanum carbonate, Sveram, calcium carbonate and calcium acetate had no significant difference in the range of phosphorus reduction, the product of calcium and phosphorus in blood, and the level of IPTH.The effects of lanthanum carbonate and sparviram on serum calcium were not significantly different from those of placebo, and were significantly lower than those of calcium carbonate and calcium acetate.The incidence of hypercalcemia in Sveram group was significantly lower than that in calcium carbonate and calcium acetate, and there was not enough evidence for network Meta analysis of endpoints such as hospitalization rate, vascular calcification, bone disease, mortality and so on.Conclusion: lanthanum carbonate (Sveram, lanthanum carbonate) is effective and safe in the treatment of hyperphosphatemia in maintenance hemodialysis patients.Lanthanum carbonate and Sveram had less effect on serum calcium than calcium and phosphorus binders, and could reduce the incidence of hypercalcemia in hemodialysis patients.There is still a need for large, multicenter, high-quality studies to provide further evidence for the endpoints of calcium carbonate, calcium acetate, Sveram, and lanthanum carbonate for all hospital admissions, cardiovascular events, and all-cause mortality.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R692.5

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相關(guān)期刊論文 前1條

1 張凌;王文博;;繼發(fā)性甲狀旁腺功能亢進癥的不同甲狀旁腺切除術(shù)式治療[J];中國血液凈化;2011年05期

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