目的 系統(tǒng)評價碳酸鑭聯(lián)用醋酸鈣或碳酸鈣治療血液透析患者高磷血癥的有效性和安全性。方法 計算機檢索PubMed、Embase、Cochrane圖書館，中國學術(shù)期刊全文數(shù)據(jù)庫（CNKI）、中國生物醫(yī)學文獻數(shù)據(jù)庫（CBM）、維普中文期刊全文數(shù)據(jù)庫（VIP）和萬方數(shù)據(jù)庫，納入碳酸鑭聯(lián)用醋酸鈣或碳酸鈣治療血液透析患者高磷血癥的臨床隨機對照試驗（RCT），檢索時限均為建庫起至2020年10月，篩選文獻并進行質(zhì)量評價后，采用RevMan 5.3軟件進行Meta分析。結(jié)果 共納入12項RCTs，1 066例患者。Meta分析結(jié)果顯示：（1）相對于醋酸鈣或碳酸鈣單用，碳酸鑭聯(lián)用醋酸鈣或碳酸鈣顯著提高臨床有效率[RR=1.32，95% CI=（1.22，1.42），P<0.01]、降低血磷水平[MD=-0.35，95% CI=（-0.44，-0.27），P<0.01]、血鈣水平[MD=-0.17，95% CI=（-0.23，-0.11），P<0.01]和免疫反應(yīng)性甲狀旁腺激素水平[MD=-50.44，95% CI=（-69.71，-31.16），P<0.01]，未顯著增加不良反應(yīng)發(fā)生率[RR=0.96，95% CI=（0.62，1.50），P=0.87]；（2）相對于碳酸鑭單用，碳酸鑭聯(lián)用醋酸鈣或碳酸鈣顯著提高臨床有效率[RR=1.26，95% CI=（1.09，1.45），P<0.01]，降低血磷水平[MD=-0.24，95% CI=（-0.31，-0.17），P<0.01]、免疫反應(yīng)性甲狀旁腺激素水平[MD=-30.09，95% CI=（-52.76，-7.43），P<0.01]，未增加血鈣水平[MD=0.09，95% CI=（-0.04，0.23），P=0.18]和不良反應(yīng)發(fā)生率[RR=1.03，95% CI=（0.46，2.33），P=0.94]。結(jié)論 碳酸鑭聯(lián)用醋酸鈣或碳酸鈣治療血液透析患者高磷血癥的臨床療效優(yōu)于醋酸鈣或碳酸鈣單用和碳酸鑭單用，且未顯著增加不良反應(yīng)發(fā)生率。

Objective To systematically evaluate the efficacy and safety of lanthanum carbonate combined with calcium acetate or calcium carbonate in the treatment of hyperphosphatemia patients with hemodialysis. Methods Computer retrieval was conducted in PubMed, Cochrane Library, Medline, CNKI, CMB, VIP and Wanfang database and randomized controlled trials (RCT) about lanthanum carbonate combined with calcium acetate or calcium carbonate in the treatment of hyperphosphatemia patients with hemodialysis from the establishment of the database to October 2020. Meta-analysis was performed using ReVMan 5.3 software after literature screening and quality assessment. Results A total of 12 RCTs involving 1 066 patients were included totally. Metaanalysis results showed that:(1) Compared with single using of calcium acetate or calcium carbonate, lanthanum carbonate combined with calcium acetate or calcium carbonate could significantly improve the clinical effective rate[RR=1.32, 95%CI= (1.22 to 1.42), P < 0.01], reduce blood phosphorus levels[MD=-0.35, 95%CI=(-0.44 to -0.27), P < 0.01], blood calcium Level[MD=0.17, 95%CI=(0.23 to 0.11), P < 0.01], and immunoreactive parathyroid hormone (iPTH) level[MD=47.98, 95%CI=(-65.62 to -30.34), P < 0.01], did not significantly increase the incidence of ADR[RR=0.96, 95%CI=(0.62 to 1.50), P =0.87]; (2) compared with single use of lanthanum carbonate, lanthanum carbonate combined with calcium acetate or calcium carbonate could significantly improve the clinical effective rate[RR=1.26, 95%CI=(1.09 to 1.45), P < 0.01], reduce blood phosphorus levels[MD=-0.24, 95%CI=(-0.31 to -0.17), P < 0.01] and iPTH lever[MD=-30.09, 95%CI=(-52.76 to -7.43), P < 0.01], and no increasing blood calcium level[MD=0.09, 95%CI=(-0.04 to 0.23, P =0.18] and the incidence of ADR[RR=1.03, 95%CI=(0.46 to 2.33), P =0.94]. Conclusion The clinical efficacy of lanthanum carbonate combined with calcium acetate or calcium carbonate in the treatment of hyperphosphatemia patients with hemodialysis is better than that of calcium acetate or calcium carbonate alone and lanthanum carbonate alone, and does not significantly increase the incidence of adverse reactions.

R973

湖北省自然科學基金資助項目（2015CFC823）