摘要
目的:系统评价清热利湿法治疗慢性肾脏病(chronic kidney disease,CKD)的临床疗效。方法:计算机检索中国知网(CNKI)、万方(WanFang Data)、维普(VIP)和PubMed数据库自建库至2020年4月关于在西医常规治疗的基础上应用清热利湿法中药汤剂治疗CKD的随机对照临床试验类文献。采用Cochrane评分量表进行文献质量评估,并应用Stata 15统计软件对最终纳入的文献数据进行荟萃分析。结果:研究共纳入33篇文献,含2558例CKD患者,其中B级文献29篇,C级文献4篇,总体文献质量偏低。荟萃分析结果发现,在西医常规治疗的基础上联合使用清热利湿法中药汤剂对CKD患者估算肾小球滤过率(eGFR)、患者血清肌酐(Scr)及24 h尿蛋白定量(24 h UP)水平的改善效果优于西医常规治疗。亚组分析结果发现:对于改善eGFR方面,CKD不同分期可能是eGFR整体研究异质性的来源之一。对于降低Scr水平方面,随着CKD病程的进展,中医清热利湿法对于CKD患者Scr降低的效应量绝对值也随之增加,整体数据显示试验组与对照组相比,Scr呈降低趋势。根据原发病不同进行亚组分析时发现,试验组与对照组相比,对于原发病为高尿酸血症肾病患者的Scr降低效果较好。结论:在西医常规治疗的基础上合用中医清热利湿法中药汤剂对于改善CKD患者肾功能相关实验室指标方面可能具有优势,但需要高质量证据进一步确认。
Objective:To evaluate the effectiveness of clearing heat and promoting diuresis in treating patients with chronic kidney disease(CKD).Methods:Computer retrieval of Chinese National Knowledge Infrastructure(CNKI),VIP Database for Chinese Technical Periodicals(VIP),Wanfang digitize Database,and PubMed to collect data on oral clearing heat and promoting diuresis method in the treatment of CKD from randomized controlled trials(RCTs),which were published as of April 2020.According to the predetermined inclusion and exclusion criteria,two researchers completed study selection and data extraction independently.Cochrane collaboration quality evaluation form was used to assess the literature's quality.The STATA software version 15 was employed to manage and analyze data.Results:A total of 33 Chinese articles involving 2558 patients who had been diagnosed as CKD were analyzed,with 1308 cases in experimental group and 1250 cases in control.Among the 33 literatures,there were 29 literatures of Grade B and 4 literatures of Grade C,indicating that the overall quality of literatures was low.The primary results of this meta-analysis demonstrated that CKD patients treated by clearing heat and promoting diuresis therapy of Chinese traditional medicine(TCM)combined with conventional western medicine had got the effective improvement in eGFR level,compared to the control group who used conventional western medicine only.Meanwhile,the combined treatment plan can reduce Scr and 24-hour urinary protein quantity(24 h UP)at the same time.In terms of improving eGFR,different stages of CKD may be one of the sources of heterogeneity in eGFR overall studies.As for the reduction of Scr level,with the progression of the disease course of CKD,the absolute value of the effect of oral clearing heat and promoting diuresis method on the reduction of Scr in patients with CKD also increased,and the overall data showed that compared with the control group,Scr level showed a decreasing trend.Furthermore,subgroup analysis showed that the Scr reduction e
作者
罗慜婧
严美花
牛文全
周学峰
王颖
李平
LUO Minjing;YAN Meihua;NIU Wenquan(Beijing University of Chinese Medicine,Beijing,100029;Institute of Clinical Medical Sciences,China-Japan Friendship Hospital,Beijing,100029)
出处
《中国中西医结合肾病杂志》
2021年第4期310-317,共8页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
国家自然科学基金资助项目(No.81620108031)。
关键词
慢性肾脏病
清热利湿法
随机对照
系统评价
荟萃分析
Chronic kidney disease
Clearing heat and promoting diuresis therapy
Randomized controlled trial
System evaluation
Meta-analysis
