奈西立肽对心力衰竭患者肾功能影响的系统评价

Effect of nesiritide on renal function of patients with heart failure：a systematic review

摘要:

目的：系统评价奈西立肽对心力衰竭患者肾功能的影响。方法：计算机检索PubMed、EMbase、Cochrane Library、OVID、万方、CNKI、VIP、CBM等数据库，检索时限为建库至2014年6月，手工检索会议文献及杂志。采用 Cochrane系统评价手册 5.1.0 推荐的方法进行文献筛选、纳入研究质量评价、数据提取及meta分析。结果：共检出642篇文献，最终纳入28篇随机对照试验文献。Meta分析结果显示，奈西立肽与对照组（治疗剂量的硝酸甘油、硝普钠、多巴酚丁胺、利尿剂或空白对照）相比，对血肌酐（serum creatinine，SCr）、血尿素氮（blood urea nitrogen，BUN）、肌酐清除率（creatinine clearance rate，Clcr或Ccr）、胱抑素C （cystatin C）的影响无统计学差异：SCr：WMD=1.97，95％CI=-1.41～5.34，P=0.250；BUN：WMD=-0.21，95％CI=-1.01～0.60，P=0.610；Clcr：WMD=4.22，95％CI=-2.67～11.11，P=0.230；Cystatin C：WMD=0.06，95％CI=-0.24～0.36，P=0.690；但在改善肾小球滤过率（glomerulai filtration rate，GFR）方面奈西立肽组优于对照组：WMD=12.40，95％CI=8.87～15.93，P=0.000。结论：与其他心衰治疗的常用药物相比，奈西立肽不会影响心衰患者的肾功能，反而可改善肾小球滤过率，在心衰的治疗中是较安全的药物之一。

Abstract:

Objective：To assess the impact of nesiritide on renal function of patients with heart failure. Methods：All the relevant liter－atures were searched from PubMed，Embase，Cochrane Library，OVID，Wangfang，CNKI，VIP，CBM，etc. Papers of related journals and conferences were also manually searched. Then the quality of included studies and extracted data were assessed and Meta-analysis was conducted with the evaluation method recommended by the guide of Cochrane Systematic Review 5.1.0. Results：A total of 642 articles were retrieved，but only 28 randomized controlled trials were finally included. The Meta-analysis showed that there was no significant difference in rising serum creatinine（SCr），blood urea nitrogen（BUN），creatinine clearance rate（Clcr），Cystatin C between the nesiritide group and the contrast（the therapeutic dose of nitroglycerin，sodium nitrate，dobutamine，diuretics and blank）（SCr：WMD=1.97，95％CI=-1.41 to 5.34，P=0.250；BUN：WMD=-0.21，95％CI=-1.01 to 0.60，P=0.610；Clcr：WMD=4.22，95％CI=-2.67 to 11.11，P=0.230；Cystatin C：WMD=0.06，95％CI=-0.24 to 0.36，P=0.690）. Meanwhile nesiritide was better in improving glomerular filtration rate（GFR） than the contrast（WMD=12.40，95％CI=8.87 to 15.93，P=0.000）. Conclusion：Compared with the other commonly used drugs of heart failure treatment，nesiritide doesn’t significantly affect the renal function of patients with heart failure，instead of improving GFR. So it is one of the safe drugs in the treatment of heart failure.