The Effect Of Metformin On The Safety Of Iodine Contrast Media:a Meta-Analysis

Objective:To investigate the safety of iodine contrast agent in patients taking metformin.Methods:With"metformin","contrast-induced acute kidney injury","lactic acidosis"and"contrast media"as keywords,seven electronic databases including Pub Med,EMBASE,Cochrane Library,Web of science,Sino Med,CNKI and Wanfang Medical Network were searched by subject words+free words,and related materials were searched by hand.Contrast-induced acute kidney injury and lactic acidosis were taken as the main outcome indexes,while postoperative serum creatinine and estimated glomerular filtration rate were used as secondary outcome indexes for meta analysis.In all studies,metformin combined with iodine contrast agent was used as the experimental group,and iodine contrast agent alone was used as the control group.The literature was screened according to the inclusion and exclusion criteria.The software Revman5.3 was used for data analysis,Cochrane risk bias and NOC scale assessment tools were used to evaluate the quality of the literature.Cochrane’s Q test was used to test the heterogeneity of the literature included in the study,and the heterogeneity between the studies was evaluated according to the I~2 value.Draw the forest plot and analyze the results,and use the funnel plot to evaluate the publication bias.Results:Finally,8 articles were included,including 3 randomized controlled trials(RCT)and 7 cohort studies.A total of 1994 patients were included in the study.The quality of all the articles included is high.The baseline data such as sex,age,cardiac function and renal function were comparable.Main outcome indicators:(1)CI-AKI:the incidence of CI-AKI in the experimental group was lower than that in the control group,but there was nostatisticaldifference[RR=0.83,95%(0.65,1.05),P=0.11].(2)Lactic acidosis(LA):the incidence of lactic acidosis in both groups was 0 in the included study.Secondary outcome indicators:(1)postoperative creatinine:the level of serum creatinine in the experimental group was lower than that in the control group,and the difference was statistically significant[SWD=-0.32,95%(-0.45,-0.19),P<0.00001].(2)postoperative estimated glomerular filtration rate in(e GFR):The level of e GFR in the experimental group was higher than that in the control group,and the differencewasstatisticallysignificant[SWD=0.45,95%(0.27,0.64),P<0.00001].Conclusions:For patients with normal or mildly impaired renal function,metformin is not a risk factor for CI-AKI and lactic acidosis,and metformin does not lead to the decline of renal function.