阿魏酸哌嗪联合血液透析治疗肾综合征出血热致急性肾衰竭的系统评价

Systematic Review of Piperazine Ferulate Combined with Hemodialysis in Treatment of Acute Renal Failure Induced by Hemorrhagic Fever with Renal Syndrome

目的:系统评价阿魏酸哌嗪联合血液透析治疗肾综合征出血热致急性肾衰竭的有效性和安全性,为临床合理用药提供循证证据。方法:计算机检索中国知网、维普数据库、万方数据库、Pubmed、EMbase及the Cochrane Library等数据库,查找阿魏酸哌嗪联合血液透析治疗肾综合征出血热致急性肾衰竭的随机对照试验(观察组采用常规药物+常规血液透析+阿魏酸哌嗪片联合治疗;对照组采用常规药物+常规血液透析治疗),采用Rev Man 5.3软件进行文献荟萃分析(Meta分析)。结果:共纳入5篇文献,合计466例患者。Meta分析结果显示,观察组患者的治愈率(RR=1.19,95%CI=1.09~1.30,P<0.000 01)、死亡率(RR=0.35,95%CI=0.14~0.86,P<0.02)、血浆内皮素下降幅度(MD=-11.05,95%CI=-17.46^-4.65,P<0.000 7)、SCr下降幅度(MD=-213.79,95%CI=-230.34^-197.24,P<0.000 01)、血尿素氮达标时间(MD=-3.13,95%CI=-3.51^-2.76,P<0.000 01)及尿蛋白消失时间(MD=-3.46,95%CI=-4.37^-2.56,P<0.000 01)明显优于对照组,差异均有统计学意义。两组患者不良反应发生率的差异无统计学意义(RR=0.57,95%CI=0.28~1.15,P=0.12)。结论:阿魏酸哌嗪联合血液透析能够有效治疗肾综合征出血热致急性肾衰竭,保护肾功能,改善患者预后,且不良反应发生率低,患者耐受好。由于本研究纳入文献的研究方法学质量不高,有待进一步进行高质量的研究对其疗效及安全性进行验证,应谨慎对待本研究结果。

OBJECTIVE： To systematically review the efficacy and safety of piperazine ferulate combined with hemodialysis in treatment of acute renal failure induced by hemorrhagic fever with renal syndrome,so as to provide evidence-based evidence for clinical rational drug application. METHODS： Randomized controlled trials（ the observation group was given combined therapy of conventional drugs ＋ conventional hemodialysis ＋ Piperazine ferulate tablets; the control group was given conventional drugs ＋ conventional hemodialysis） on piperazine ferulate combined with hemodialysis in treatment of acute renal failure induced by hemorrhagic fever with renal syndrome were retrieved from CNKI,VIP,Wanfang,Pubmed,EMbase and Cochrane Library,then Rev Man 5. 3 was adopted to conduct Meta analysis. RESULTS： A total of 5 studies were involved,including 466 patients. Results of Meta analysis indicated that the cure rate（ RR = 1. 19,95% CI = 1. 09-1. 30,P〈0. 000 01）,mortality（ RR = 0. 35,95% CI = 0. 14-0. 86,P〈0. 02）,decreasing amplitude of plasma endothelin（ MD =-11. 05,95% CI =-17. 46--4. 65,P〈0. 000 7）,decreasing amplitude of serum creatinine（ MD =-213. 79,95% CI =-230. 34--197. 24,P〈0. 000 01）,time required of blood urea nitrogen level for reaching the standard（ MD =-3. 13,95% CI =-3. 51--2. 76,P〈0. 000 01） and disappearance time of urine protein（ MD =-3. 46,95% CI =-4. 37--2. 56,P〈0. 000 01） of observation group were significantly better than those of the control group,with statistically significant differences. There was no statistical significance in difference of incidences of adverse drug reactions between two groups（ RR = 0. 57,95% CI =0. 28-1. 15,P = 0. 12）. CONCLUSIONS： The efficacy of piperazine ferulate combined with hemodialysis in treatment of acute renal failure induced by hemorrhagic fever with renal syndrome is remarkable,which can protect renalfunction,improve patients＇ prognoses,with low incidence of adverse drug reactions and good tolerance. However,due to the low methodology quality of involved studies,the efficacy and safety of piperazine ferulate need verification by further research with high quality,therefore the results of this study should be treated with caution.