| Objective:The aim of this study was to evaluate the efficacy of prostaglandin E1(PGE1)in preventing CIN.Methods: We searched Pub Med,Embase,Cochrane Library,Chinese Biomedical Literature,China National Knowledge Infrastructure,VIP Information/Chinese Scientific Journals,and WANFANG databases for randomized controlled trials(RCTs)and quasi-RCT comparing the preventive effects of PGE1 versus controls(conventional hydration,no alprostadil,or placebo)on CIN in patients undergoing percutaneous coronary proceduresm,through January 1999 to June 2016.Relevant key words relating to PGE1 in combination with Medical Subject Headings terms and text words(“prostaglandin E1” OR “PGE1” OR “lipo-PGE1” OR “alprostadil”),as well as words relating to CIN,were used.Study characteristics and outcome data were abstracted by two independent reviewers;the risk of bias was also assessed by two reviewers.Results: Ttirty-three RCTs involving 4528 patients were included.Compared with control groups,PGE1 reduced the risk of CIN significantly[6.71% vs 16.99%,risk ratio(RR)=0.39,95%confidence interval(CI)(0.33,0.47),P<0.01,I2 = 0].In the chronic kidney disease(CKD)patients,PGE1 reduced the risk of CIN compared with control groups[9.04% vs 22.07%,RR=0.45,95%CI(0.30,0.66),P<0.001].In the diabetic mellitus patients,PGE1 reduced the risk of CIN compared with control groups[11.07% vs 27.16%,RR=0.41,95%CI(0.31,0.53),P<0.001].In the acute coronary syndrome patients(ACS),PGE1 reduced the risk of CIN compared with control groups [10.0% vs 24.05%,RR=0.45,95%CI(0.30,0.66),P=0.001].Serum creatinine levels in the PGE1 groups were all significantly lower than the control groups at 24,48,and 72 hours after operation(mean difference(MD)=-9.86,95% CI(-17.16,-2.56),P=0.008;MD=-15.71,95% CI(-21.69,-9.74),P<0.001;MD=-12.55,95% CI(-16.20,-8.90),P<0.001] respectively).Blood urea nitrogen levels in the PGE1 groups were all significantly lower than the control groups at 24,48,and 72 hours after operation[MD=-0.65,95% CI(-1.14,-0.17),P<0.001;MD=-1.08,95% CI(-1.36,-0.80),P<0.001;MD=-1.35,95% CI(-2.12,-0.58),P<0.001,respectively].Estimated glomerular filtration rate levels in the PGE1 groups were all significantly lower than the control groups at 24,48,and 72 hours after operation[MD= 4.48,95% CI(1.74,7.22),P=0.001;MD= 7.53,95% CI(3.54,11.51),P<0.001;MD= 7.08,95% CI(2.70,11.46,P=0.002,respectively].Serum cystatin C levels in the PGE1 groups were all significantly lower than the control groups at 24,48,and 72 hours after operation[MD=-0.27,95% CI(-0.42,-0.12),P<0.001;MD=-0.30,95% CI(-0.47,-0.12),P<0.001;MD=-0.27,95% CI(-0.44,-0.11),P=0.001,respectively].Urine ?2-microglobulin levels in the PGE1 group were significantly lower than the control group at 48,72 hours after operation[MD=-56.78,95% CI(-85.53,-28.03),P<0.001;MD=-50.42,95% CI(-59.21,-41.63),P<0.001,respectively].Urine neutrophil gelatinase associated lipocalin and the need of the need of dialysis between two groups have no difference[MD=-7.58,95%CI(-15.16,0.00),P<0.05;RR=0.37,95%CI(0.10,1.36),P=0.16,respectively].Conclusion: Prostaglandin E1 may play an important role in reducing the incidence of CIN in patients undergoing percutaneous coronary procedures;especially it could protect the renal function in CKD?diabetic mellitus and ACS patients.This study found that among the observational indicators,serum creatinine,blood urea nitrogen,blood cystatin C,estimated glomerular filtration rate,and urinary ?2 microglobulin all showed statistical results in comparison between the short-term(24h,48 h,and 72h)groups suggesting that the above indicators can accurately reflect the changes in renal function.We also find that PGE1 can not decrease the need of renal replacement therapy,so it is limited in patients with seriously renal insufficiency. |
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