健脾益肾法治疗慢性肾衰竭非透析患者营养不良Meta分析

Strengthening Spleen and Nourishing Kidney Therapy for Malnutrition on Non-Dialysis Chronic Renal Failure Patients:A Meta-analysis

目的系统评价健脾益肾法治疗慢性肾衰竭非透析患者营养不良的临床疗效及安全性。方法计算机检索中国知网数据库(CNKI)、万方数据库、重庆维普全文数据库(VIP)、中国生物医学文献数据(CBM)、PubMed、Central、Embase等数据库中运用中医健脾益肾法治疗慢性肾衰竭非透析患者营养不良的临床文献,并辅以手工检索。检索时限为建库之日起至2018年10月。由2名研究员依据预设纳入和排除标准进行质量评价、数据资料提取,采用Cochrane协作网提供的RevMan 5.3软件进行Meta分析。结果最终纳入8项研究,共527例患者。与对照组相比,中医健脾益肾法更有效的提高了慢性肾衰竭非透析营养不良患者前白蛋白(PA)、血清白蛋白(Alb)、转铁蛋白(TF),降低了血肌酐(Scr)、主观综合营养评估(SGA),中医症状得到明显改善。结论健脾益肾法治疗慢性肾衰竭非透析患者营养不良方面总体比单用西药治疗更有优势,但所有纳入的文献方法学评价质量偏低,存在发表偏倚,仍需更多大样本、多中心、高质量的随机双盲对照临床试验进行验证。

Objective To evaluate the clinical efficacy and safety of the strengthening spleen and nourishing kidney therapy in the treatment of malnutrition in non-dialysis chronic renal failure patients.Methods By searching the databases including CNKI,Wanfang,VIP,CBM,PubMed,the Central,Embase and other databases,the clinical literature concerning malnutrition on non-dialysis chronic renal failure patients treated by the strengthening spleen and nourishing kidney therapy was screened,supplemented by manual retrieval.The search period was from the date of establishment to October,2018.Two investigators evaluated the quality and extracted the data according to the pre-set inclusion and exclusion criteria,followed by Meta-analysis using RevMan 5.3 software provided by the Cochrane Collaboration.Results There were 8 studies eventually enrolled,including 527 patients.Compared with the control group,the strengthening spleen and nourishing kidney therapy could effectively improve serum levels of albumin(Alb),prealbumin(PA)and transferrin(TF),reduce serum levels of creatinine(Scr),subjective comprehensive nutrition assessment(SGA)and significantly improve symptoms of TCM.Conclusion The strengthening spleen and nourishing kidney therapy for the treatment of malnutrition on non-dialysis chronic renal failure patients is generally more advantageous than the western treatment alone,but the quality of the included literature was low,indicated by the methodological evaluation.There may be the risk of publication bias.Therefore,it needs more large sample,multi-center and high quality randomized double-blind controlled clinical trials to verify.