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目的:循证评价碳酸镧在非透析慢性肾脏病患者中的有效性和安全性。方法:系统检索Pub Med,Embase,Cochrane Library以及CNKI,CBM和Wan Fang数据库,获取公开发表的相关随机对照研究,对其方法学质量进行评估,对符合条件的数据进行Meta分析。结果:纳入9篇研究,共534例患者。与安慰剂相比,碳酸镧可显著降低基线患高磷血症的患者的血磷水平[加权均数差WMD:-0.52(-0.92,-0.12)mmol·L-1,P=0.01],但对基线血磷水平正常的患者没有影响[WMD:-0.00(-0.11,0.10)mmol·L-1,P=0.95],同时可显著降低钙磷乘积(Ca x P)水平;与含钙磷结合剂相比,碳酸镧可显著降低血清全段甲状旁腺素(intact parathyroid hormone,i PTH)和血清全段成纤维细胞生长因子23(intact fibroblast growth factor23,i FGF23)水平,高钙血症发生率显著降低[风险比RR:0.10(0.01,1.68),P=0.11]。全因死亡率和不良事件与安慰剂、含钙磷结合剂和司维拉姆相比均无显著差异。结论:基于现有证据,碳酸镧在非透析肾脏患者中具有良好的有效性和安全性。
Objective: To evaluate the effectiveness and safety of lanthanum carbonate in non-dialysis chronic kidney disease patients. Methods: PubMed, Embase, Cochrane Library and CNKI, CBM and Wan Fang databases were searched systematically to obtain published published randomized controlled studies. The methodological quality was evaluated and Meta-analysis was performed on eligible data. Results: Nine studies were included in 534 patients. Compared with placebo, lanthanum carbonate significantly decreased serum phosphorus levels in patients with baseline hyperphosphatemia (weighted mean difference, WMD: -0.52 (-0.92, -0.12) mmol·L-1, P = 0.01] But had no effect on patients with normal baseline phosphorus levels [WMD: -0.00 (-0.11,0.10) mmol·L-1, P = 0.95], and at the same time significantly reduced the level of calcium and phosphorus products (Ca x P) Lanthanum carbonate could significantly decrease the level of serum intact parathyroid hormone (i PTH) and serum intact fibroblast growth factor 23 (i FGF23) The incidence of disease was significantly lower [hazard ratio RR: 0.10 (0.01, 1.68), P = 0.11]. All-cause mortality and adverse events did not differ significantly from placebo, calcium-phosphate-binding agents, and sevelamer. Conclusion: Based on available evidence, lanthanum carbonate has good efficacy and safety in non-dialysis kidney patients.