非諾貝特對腎功能影響的Meta分析_《中國循證醫學雜志》

作者：

徐川 , 袁自靜 ,  朱江

南京市江寧醫院腎內科（南京　211110）;

關鍵詞：

非諾貝特尿酸系統評價 Meta分析隨機對照試驗半隨機對照試驗

DOI：

10.7507/1672-2531.20130233

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目的　系統評價非諾貝特對不同人群腎功能的影響，為臨床上高尿酸血癥治療方案的選擇提供參考。
方法　計算機檢索PubMed（1966～2013）、EMbase（1984～2013）、The Cochrane Library（2012年第1期）、CBM（1978～2013）和CNKI（1989～2013）等數據庫，同時手工檢索《中西醫結合雜志》及國內腎臟疾病相關雜志，納入非諾貝特干預相關隨機或半隨機對照試驗。按Cochrane系統評價方法，由2名評價員獨立進行文獻篩選、資料提取和評價納入研究的方法學質量后，采用RevMan 5.0軟件進行Meta分析。
結果　共納入16個研究，包括346例患者。Meta分析結果顯示：① 經非諾貝特治療后，患者血清尿酸改善優于對照組［WMD=48.68，95%CI（10.02，87.34），P lt;0.000 01］；內生肌酐清除率較對照組下降［WMD=8.88，95%CI（1.29，16.47），P=0.002］；血清肌酐的變化與對照組差異無統計學意義［WMD=1.78，95%CI（–2.86，6.42），P=0.45］。② 不良反應主要有胃腸道不適、皮疹、GPT、轉氨酶等一過性升高，但大多癥狀輕微。
結論　非諾貝特對于降低血尿酸有較好的療效，但由于納入文獻方法學質量不高，確切療效及有關毒副作用有待于設計嚴格的多中心、大樣本、隨機雙盲臨床對照試驗進一步證實。

引用本文： 徐川,袁自靜,朱江. 非諾貝特對腎功能影響的Meta分析. 中國循證醫學雜志, 2013, 13(11): 1361-1366. doi: 10.7507/1672-2531.20130233 復制

1.	The FIELD study investigators. Effect of long term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet, 2005, 366(9500): 1849.
2.	Bastow MD, Durrington PN, Ishola M. Hypertriglyceridemia and hyperuricemia: effects of two fibric acid derivatives (bezafibrate and fenofibrate) in a double-blind, placebo-controlled trial. Metabolism, 1988, 37(3): 217-220.
3.	Obermayr RP, Temml C, Gutjahr G, et al. Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol, 2008, 19(12): 2251-2253.
4.	Liamis G, Bairaktari ET, Eliasf M. Effect of fenofibrate on serum uric acid levels. Am J Kidney Dis, 1999, 34: 594.
5.	YamamokT, MoriwakiY, Takahashi S, et al. Effect offenofibrate on plasma concentration and urinary excretion of purine bases and oxyPurinol. Eur J ClinInvest, 2000, 30(10): 871-878.
6.	王慧華, 李開滬, 朱秀英. 微粒化非諾貝特與苯扎貝特治療老年高脂血癥和高尿酸血癥的比較. 老年醫學與保健, 1999, 5(2): 73-75.
7.	Elisaf M, Tsimichodimos V, Bairaktari E, et al. Effect of Micronized Fenofibrate and Losartan Combination on Uric Acid Metabolism in Hypertensive Patients with Hyperuricemia. Journal of Cardiovascular Pharmacology, 1999, 34(1): 60-63.
8.	張文姚, 任愛華, 蔣益忠. 自身交叉試驗比較非諾貝特與辛伐他汀降脂療效及對ApoA、ApoB的影響. 心血管康復醫學雜志, 2000, 9(2): 35-37.
9.	王守俊, 劉瑞芳, 魏巧蘭. 非諾貝特對糖尿病腎病的前瞻性研究. 遼寧實用糖尿病雜志, 2001, 9(3): 27-28.
10.	Giral P, Bruckert E, Jacob N, et al. Homocysteine and lipid lowering agents. A comparison between atorvastatin and fenobrate in patients with mixed hyperlipidemia. Atherosclerosis, 2001, 154(2): 421-427.
11.	Insua A, Massari F, Moncalvo JJR, et al. Fenofibrate of gemfibrozil for treatment of types IIa and IIb primary hyperlipoproteinemia: a randomized, double-blind, crossover study. Endocr Pract, 2002, 8(2): 96-101.
12.	秦利, 殷峻, 邢惠莉. 非諾貝特緩釋微丸對糖尿病患者糖脂代謝紊亂的影響. 上海第二醫科大學學報, 2003, 23(3): 261-263.
13.	Milionis HJ, Papakostas J, Kakafika A, et al. Comparative effects of atorvastatin, simvastatin, and fenofibrate on serum homocysteine levels in patients with primary hyperlipidemia. J Clin Pharmacol, 2003, 43(8): 825-830.
14.	孫學春. 微粒化非諾貝特對老年人血脂代謝紊亂的療效觀察. 四川醫學, 2005, 26(9): 975-976.
15.	Filippatos TD, Kiortsis DN, Liberopoulos EN, et al. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin, 2005, 21(12): 1997-2006.
16.	劉玉慶, 史淑琴, 趙勇. 逐酸活血湯治療原發性高尿酸血癥并高三酰甘油血癥30例的療效觀察. 中國實用醫藥, 2008, 3(34): 60-62.
17.	Ansquer JC, Dalton RN, Caussé E, et al. Effect of fenofibrate on kidney function: a 6-week randomized crossover trial in healthy people. Am J Kidney Dis, 2008, 51(6): 904-913.
18.	王一揚, 王亦凡, 高振英. 非諾貝特治療高甘油三酯癥和高尿酸癥的療效. 藥學與臨床, 2009, 12(12): 1787-1789.
19.	劉茜. 非諾貝特和普伐他汀調節血脂及尿酸的研究. 中華全科醫學, 2010, 8(1): 60-62.
20.	王大鵬, 高燕燕. 非諾貝特和苯溴馬隆治療高尿酸血癥的效果. 齊魯醫學雜志, 2010, 25(6): 524-527.
21.	Goto M. A comparative study of anti-inflammatory and antidyslipidemic effects of fenofibrate and statins on rheumatoid arthritis. Mod Rheumatol, 2010, 20(3): 238-243.
22.	Filippatos TD, Kiortsis DN, Liberopoulos EN, et al. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin, 2005, 21(12): 1997-2006.
23.	Milionis HJ, Elisaf MS. Management of hypertension and dyslipidaemia in patients presenting with hyperuricaemia: case histories. Curr Med Res Opin, 2000, 16(3): 164-170.
24.	Daskalopoulou SS, Tzovaras V, Mikhailidis DP, et al. Effect on serum uric acid levels of drugs prescribed for indications other than treating hyperuricaemia. Curr Pharm Des, 2005, 11(32): 4161-4175.
25.	Lipscombe J, Bargman JM. Fibrate-induced increase in blood urea and creatinine. Nephrol Dial Transplant, 2001, 16(7): 1515.
26.	Davis TME, Ting R, Best JD, et al. Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study. Diabetologia, 2011, 54(2): 280–290.
27.	Katsiki N, Papanas N, Fonseca VA, et al. Uric acid and diabetes: is there a link? Curr Pharm Des, 2013, 19(27): 4930-4937.

1. The FIELD study investigators. Effect of long term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet, 2005, 366(9500): 1849.
2. Bastow MD, Durrington PN, Ishola M. Hypertriglyceridemia and hyperuricemia: effects of two fibric acid derivatives (bezafibrate and fenofibrate) in a double-blind, placebo-controlled trial. Metabolism, 1988, 37(3): 217-220.
3. Obermayr RP, Temml C, Gutjahr G, et al. Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol, 2008, 19(12): 2251-2253.
4. Liamis G, Bairaktari ET, Eliasf M. Effect of fenofibrate on serum uric acid levels. Am J Kidney Dis, 1999, 34: 594.
5. YamamokT, MoriwakiY, Takahashi S, et al. Effect offenofibrate on plasma concentration and urinary excretion of purine bases and oxyPurinol. Eur J ClinInvest, 2000, 30(10): 871-878.
6. 王慧華, 李開滬, 朱秀英. 微粒化非諾貝特與苯扎貝特治療老年高脂血癥和高尿酸血癥的比較. 老年醫學與保健, 1999, 5(2): 73-75.
7. Elisaf M, Tsimichodimos V, Bairaktari E, et al. Effect of Micronized Fenofibrate and Losartan Combination on Uric Acid Metabolism in Hypertensive Patients with Hyperuricemia. Journal of Cardiovascular Pharmacology, 1999, 34(1): 60-63.
8. 張文姚, 任愛華, 蔣益忠. 自身交叉試驗比較非諾貝特與辛伐他汀降脂療效及對ApoA、ApoB的影響. 心血管康復醫學雜志, 2000, 9(2): 35-37.
9. 王守俊, 劉瑞芳, 魏巧蘭. 非諾貝特對糖尿病腎病的前瞻性研究. 遼寧實用糖尿病雜志, 2001, 9(3): 27-28.
10. Giral P, Bruckert E, Jacob N, et al. Homocysteine and lipid lowering agents. A comparison between atorvastatin and fenobrate in patients with mixed hyperlipidemia. Atherosclerosis, 2001, 154(2): 421-427.
11. Insua A, Massari F, Moncalvo JJR, et al. Fenofibrate of gemfibrozil for treatment of types IIa and IIb primary hyperlipoproteinemia: a randomized, double-blind, crossover study. Endocr Pract, 2002, 8(2): 96-101.
12. 秦利, 殷峻, 邢惠莉. 非諾貝特緩釋微丸對糖尿病患者糖脂代謝紊亂的影響. 上海第二醫科大學學報, 2003, 23(3): 261-263.
13. Milionis HJ, Papakostas J, Kakafika A, et al. Comparative effects of atorvastatin, simvastatin, and fenofibrate on serum homocysteine levels in patients with primary hyperlipidemia. J Clin Pharmacol, 2003, 43(8): 825-830.
14. 孫學春. 微粒化非諾貝特對老年人血脂代謝紊亂的療效觀察. 四川醫學, 2005, 26(9): 975-976.
15. Filippatos TD, Kiortsis DN, Liberopoulos EN, et al. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin, 2005, 21(12): 1997-2006.
16. 劉玉慶, 史淑琴, 趙勇. 逐酸活血湯治療原發性高尿酸血癥并高三酰甘油血癥30例的療效觀察. 中國實用醫藥, 2008, 3(34): 60-62.
17. Ansquer JC, Dalton RN, Caussé E, et al. Effect of fenofibrate on kidney function: a 6-week randomized crossover trial in healthy people. Am J Kidney Dis, 2008, 51(6): 904-913.
18. 王一揚, 王亦凡, 高振英. 非諾貝特治療高甘油三酯癥和高尿酸癥的療效. 藥學與臨床, 2009, 12(12): 1787-1789.
19. 劉茜. 非諾貝特和普伐他汀調節血脂及尿酸的研究. 中華全科醫學, 2010, 8(1): 60-62.
20. 王大鵬, 高燕燕. 非諾貝特和苯溴馬隆治療高尿酸血癥的效果. 齊魯醫學雜志, 2010, 25(6): 524-527.
21. Goto M. A comparative study of anti-inflammatory and antidyslipidemic effects of fenofibrate and statins on rheumatoid arthritis. Mod Rheumatol, 2010, 20(3): 238-243.
22. Filippatos TD, Kiortsis DN, Liberopoulos EN, et al. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin, 2005, 21(12): 1997-2006.
23. Milionis HJ, Elisaf MS. Management of hypertension and dyslipidaemia in patients presenting with hyperuricaemia: case histories. Curr Med Res Opin, 2000, 16(3): 164-170.
24. Daskalopoulou SS, Tzovaras V, Mikhailidis DP, et al. Effect on serum uric acid levels of drugs prescribed for indications other than treating hyperuricaemia. Curr Pharm Des, 2005, 11(32): 4161-4175.
25. Lipscombe J, Bargman JM. Fibrate-induced increase in blood urea and creatinine. Nephrol Dial Transplant, 2001, 16(7): 1515.
26. Davis TME, Ting R, Best JD, et al. Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study. Diabetologia, 2011, 54(2): 280–290.
27. Katsiki N, Papanas N, Fonseca VA, et al. Uric acid and diabetes: is there a link? Curr Pharm Des, 2013, 19(27): 4930-4937.

《中國循證醫學雜志》

非諾貝特對腎功能影響的Meta分析

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《中國循證醫學雜志》

非諾貝特對腎功能影響的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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