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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。
Objective To evaluate the effect of statin therapy on the progression of nephrosis in non-dialysis chronic kidney disease patients. Methods According to the randomized controlled trials of electronic databases (as of Feb. 2015), the randomized controlled trials were screened to meet the inclusion criteria, and the relevant indicators of renal disease progression were combined with random effects model. Results A total of 28 studies were included, including 45 688 patients with chronic kidney disease. Meta-analysis showed that non-dialysis chronic kidney disease patients receiving statins did not reduce the incidence of end-stage renal disease (RR = 0.98, 95% CI: 0.91-1.05), nor doubled creatinine (RR 1.43, 95% CI 0.26 to 7.79), but reduced the risk of ≥25% reduction in glomerular filtration rate (RR = 0.91, 95% CI: 0.83 = 0.99, and delayed glomerular filtration rate reduction SMD = 0.04, 95% CI: 0.02-0.07). Subgroup analysis showed that statin therapy was effective in detecting glomerular filtration rate before and after treatment in patients with moderate chronic kidney disease (SMD = 0.09 , 95% CI: 0.04 = 0.13) .Atvastatin (SMD = 0.10, 95% CI: 0.03-0.17) and high intensity lipid-lowering treatment (SMD = 0.12, 95% CI: Although the statin has no effect on reducing the incidence of end-stage renal disease and doubled creatinine, it can delay the decrease of glomerular filtration rate, , Drug type and lipid-lowering intensity.