维生素K2治疗慢性肾脏病患者血管钙化的系统评价

Efficacy of Vitamin K2 for Vascular Calcification in Patients with Chronic Kidney Disease: A Systematic Review

摘要: 目的：系统评价维生素K2治疗慢性肾脏病患者血管钙化的临床疗效及安全性。方法：全面检索关于维生素K2治疗慢性肾脏病患者血管钙化的临床随机对照研究，比较维生素K2与安慰剂、不予治疗或者其他药物对慢性肾脏病患者血管钙化的疗效和安全性。采取“主题词 + 自由词”方式进行检索，检索时限均为从建库至2023年1月，并对所获取的文献进行手工检索。两位作者独立提取数据，并评价纳入研究的质量。根据纳入和排除标准对所检索文献进行筛选，使用Jadad评分进行方法学质量评价，并采用RevMan 5.4.1软件对纳入研究的相关指标和不良反应进行统计分析。结果：本研究共纳入4篇文献，病例数为313例，实验组191例，对照组182例，其中非透析患者201例，透析患者52例，肾移植患者60例。对照措施为维生素K2与安慰剂、维生素K2 + 维生素D与维生素D、维生素K2与空白对照及前后对照。4篇文献中有3篇采用了随机对照的方法，1篇为单臂实验。2篇采用了双盲法。不存在选择性报告和偏倚情况。结果表明，给予维生素K2治疗后，可以降低DP-ucMGP、cfPWV、OC、OPG，升高MGP，抑制血管钙化。补充维生素K2后冠状动脉与颈总动脉内膜厚度均变薄，说明血管钙化程度得到减缓。实验组中仅1例患者因胃肠道症状退出研究。结论：维生素K2可降低慢性肾脏病病人的血管钙化相关性指标(DP-ucMGP、OC、OPG、钙磷乘积)，改善动脉内膜厚度，降低cfPWV，减缓血管钙化。但鉴于纳入的研究数量和质量的局限性，本文结论应审慎解读。

Abstract: Objective: To systematically evaluate the clinical efficacy and safety of vitamin K2 in the treatment of vascular calcification in patients with chronic kidney disease. Methods: A comprehensive search of randomized controlled trials on vitamin K2 in the treatment of vascular calcification in patients with chronic kidney disease was conducted to compare the efficacy and safety of vitamin K2 with placebo, no treatment, or other drugs in the treatment of vascular calcification in patients with chronic kidney disease. The retrieval time was from the establishment of the database to January 2023, and the literature was manually searched. The two authors independently extracted data and evaluated the quality of the included studies. According to the inclusion criteria and exclusion criteria, the retrieved literatures were screened. Jadad score was used to evaluate the methodological quality of the included studies. RevMan 5.4.1 software was used to analyze the related indicators and adverse reactions. Results: Four articles were included in this study, including 313 cases, 191 cases in the experimental group, and 182 cases in the control group, including 201 non-dialysis patients, 52 dialysis patients, and 60 renal transplantation patients. The control measures were vitamin K2 and placebo, vitamin K2 + vitamin D and vitamin D, vitamin K2 and blank control and before and after control. Three of the four articles were randomized controlled, and one was a single-arm experiment. Two papers used the double-blind method. There was no selective reporting or bias. The results showed that vitamin K2 could decrease DP-ucmgp, cfPWV, OC, and OPG, increase MGP, and inhibit vascular calcification. After vitamin K2 supplementation, the intima thickness of the coronary artery and common carotid artery became thinner, indicating that the degree of vascular calcification was slowed down. Only one patient in the experimental group withdrew from the study due to gastrointestinal symptoms. Conclusion: Vitamin K2 can reduce the indices related to vascular calcification (DP-ucmgp, OC, OPG, calcium-phosphorus product), improve the intimal thickness, reduce cfPWV, and slow down vascular calcification in patients with chronic kidney disease. However, in view of the limitations of the quantity and quality of the included studies, the conclusion of this paper should be interpreted carefully.