南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (04): 445-.

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他汀类药物治疗对延缓慢性肾脏病进展的荟萃分析

刘宗瑞，赵豪，陈艳荣，唐冬冬，牛红心   

  • 出版日期:2016-04-20 发布日期:2016-04-20

Effects of statins on delaying progression of chronic kidney disease: a meta-analysis

  • Online:2016-04-20 Published:2016-04-20

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摘要： 目的评价他汀类药物治疗对非透析的慢性肾脏病患者肾脏病进展的影响。方法通过对电子数据库（时间截止2015年2 月）的检索，筛选符合纳入标准的随机对照试验，采用随机效应模型合并相关肾脏病进展指标。结果共纳入28个研究，共包括 45 688例慢性肾脏病患者。Meta分析结果显示，与对照组相比，非透析的慢性肾脏病患者接受他汀类药物治疗不能减少终末期 肾病的发生（RR=0.98，95% CI：0.91-1.05），也不能降低肌酐翻倍风险（RR 1.43，95% CI 0.26 to 7.79），但是可以降低肾小球滤过 率下降≥25%的风险（RR=0.91，95% CI：0.83=0.99 以及延缓肾小球滤过率下降（SMD=0.04，95% CI：0.02-0.07）。亚组分析显 示，在中度慢性肾脏病患者中，他汀类药物治疗对治疗前后肾小球滤过率变化这一指标有疗效（SMD=0.09，95% CI：0.04= 0.13）。阿托伐他汀（SMD=0.10，95% CI：0.03-0.17）及高强度降脂治疗（SMD=0.12，95% CI：0.02-0.21）对治疗前后肾小球滤过 率变化这一指标有效。结论尽管他汀类药物对降低终末期肾病发及肌酐翻倍的发生率无明显效果，但可以延缓肾小球滤过率 下降，其疗效与肾脏病分期、药物种类及降脂强度有关。

Abstract: Objective Whether statins can slow down the progression of chronic kidney disease (CKD) remains controversial. We performed a meta-analysis to evaluate the effects of statin therapy on disease progression in adult patients with CKD who did not require dialysis therapy. Methods We searched the electronic databases for relevant randomized controlled trials (RCTs) published by February 2015. Random-effects meta-analysis of RCTs was used to pool the renal outcomes of the patients. Results Twenty-eight studies (30 RCTs) involving a total of 45 688 participants were included in the analysis. Compared with the control groups, statins produced no effects in preventing end-stage renal disease (ESRD) [relative risks (RR) 0.98, 95% confidence intervals (CI): 0.91-1.05] and in reducing the risk of doubling of the serum creatinine level (RR 1.43, 95% CI: 0.26-7.79). Statin therapy was associated with a lowered risk of estimated glomerular filtration rate (eGFR) reduction by 25% or more (RR 0.91, 95% CI: 0.83-0.99) and delayed the reduction of eGFR [standardized mean differences (SMD) 0.04, 95% CI: 0.02-0.07]. In subgroup analyses, the benefit of statins on changes in eGFR was statistically significant in patients with moderate CKD (SMD 0.09, 95% CI 0.04-0.13). Among different statins, atorvastatin was associated with a beneficial effect on kidney function (SMD 0.10, 95% CI 0.03-0.17). Patients who received high-intensity statin therapy showed significant changes in eGFR (SMD 0.12, 95% CI: 0.02-0.21). Conclusion Statin therapies may not prevent ESRD or doubling of serum creatinine level, but can improve GFR or delay the reduction of GFR in CKD patients. The therapeutic effects are associated with the patients’ baseline eGFR levels, statin types and therapy intensity.