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α-酮酸广泛应用于慢性肾脏病中,但其有效性始终存在争议。本研究便旨在评价其有效性。首先我们检索PubM ed,EMBASE,Cochrane Library、CENTRAL、CNKI和万方数据库,检索时限均从建库至2016-5-31。纳入α-酮酸联合低蛋白饮食与低蛋白饮食对照的RCT,由2位研究者独立筛选文献、提取资料并进行文献质量评价和纳入研究的偏倚风险评估,采用Rev Man 5.3软件进行Meta分析和敏感性分析。据统计,共纳入21篇RCT,1448例研究对象,其中单用低蛋白饮食治疗者722例,α-酮酸联合低蛋白饮食干预的患者726例。与低蛋白饮食组相比,α-酮酸联合低蛋白饮食能降低血清肌酐(95%CI,0.46–0.96;P<0.00001),总胆固醇(95%CI,0.24–0.77;P=0.02),总甘油三酯(95%CI,0.28–0.83;P=0.02),低密度脂蛋白(95%CI,0.12–0.54;P=0.31)并且增加高密度脂蛋白(95%CI,–1.73–0.07;P<0.00001);此外,还能降低血P3–(95%CI,0.90–1.26;P<0.00001)以及血甲状旁腺激素水平(95%CI,0.70–1.21;P=0.007)。没有高血钙等其他药物不良反应或毒性事件被报道。但荟萃分析存在较大的异质性。低质量的证据表明α-酮酸可能具有附加的改善肾脏功能、调节脂质代谢和钙磷代谢的作用。但鉴于研究较大的异质性与处方α-酮酸的成本和患者依从性问题,α-酮酸在CKD管理中的地位仍需要大规模、高质量的随机对照研究进行证实。
Alpha-keto acid is widely used in chronic kidney disease, but its effectiveness has always been controversial. This study aims to evaluate its effectiveness. First of all, we searched PubM ed, EMBASE, Cochrane Library, CENTRAL, CNKI and Wanfang Databases, all from the database to May 31, The RCTs, which included α-ketoacid combined with low-protein diet and low-protein diet, were independently screened by 2 investigators to extract data and assess the quality of the literature and evaluate the risk of bias included in the study. Meta-analysis was performed using Rev Man 5.3 software and Sensitivity analysis. According to statistics, a total of 21 RCTs were enrolled in 1448 subjects, including 722 cases treated with low-protein diet alone and 726 cases treated with alpha-keto acid combined with low-protein diet. Compared with the low-protein diet group, alpha-keto acid combined with a low-protein diet reduced serum creatinine (95% CI, 0.46-0.96; P <0.00001), total cholesterol (95% CI 0.24-0.77; Total triglycerides (95% CI, 0.28-0.83; P = 0.02), LDL (95% CI, 0.12-0.54; P = 0.31) and increased HDL (95% CI, -1.73-0.07 ; P <0.00001). In addition, blood P3- (95% CI, 0.90-1.26; P <0.00001) and parathyroid hormone levels (95% CI, 0.70-1.21; P = 0.007) were also decreased. No other adverse drug reactions or toxicity events such as hypercalcemia have been reported. However, meta-analysis there is a greater heterogeneity. Low-quality evidence suggests that alpha-keto acids may have additional beneficial effects on kidney function, regulation of lipid metabolism, and metabolism of calcium and phosphorus. However, given the large heterogeneity of research and the cost and prescription compliance of prescription alpha-keto acids, the status of alpha-keto acid in CKD management still requires large-scale, high-quality randomized controlled trials.