温阳利水益气活血法辅助治疗心肾综合征的系统评价和Meta分析

Systematic review and Meta analysis on cardiorenal syndrome in the adjuvant treatment with wenyang lishui yiqi huoxue method

目的评价温阳利水益气活血法配合西医基础疗法治疗心肾综合征(Cardiorenal Syndrome,CRS)。方法计算机检索PubMed、EMbase、Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方(WanFang)和维普(VIP)数据库,手工补充检索北京中医药大学图书馆关于中药治疗心肾综合征的重要会议集和过刊资料,由两名研究者单独筛选文献、提取资料。用软件RevMan5.3作Meta分析。结果共纳入12篇RCTs,共1011例CRS患者。Meta分析结果:温阳利水益气活血法联合西医基础疗法治疗CRS患者与单纯西药相比,①有效率:OR=2.70[95%CI:(1.90,3.84)],差异具有统计学意义(Z=5.53,P<0.000 01);②B型钠尿肽(BNP):MD=-30.32[95%CI:(-36.59,-24.04)],差异具有统计学意义(Z=9.47,P<0.000 01);③心脏射血分数(EF):SMD=0.52[95%CI:(0.23,0.80)],差异具有统计学意义(Z=3.57,P=0.000 4<0.05);④血肌酐(Scr):SMD=-1.33[95%CI:(-2.11,-0.56)],差异具有统计学意义(Z=3.37,P=0.000 7<0.05)。结论基于目前证据,温阳利水益气活血法配合西医基础疗法能够显著提高CRS的临床有效率,改善CRS患者的心、肾功能。同时在临床中应注重使用黄芪、白术、茯苓、附子、葶苈子、丹参等具有温阳利水益气活血作用的中药。

Objective To evaluate the the integrated treatment with wenyang lishui yiqi huoxue method and Western medicine for cardiorenal syndrome(CRS).Methods The relevant articles were retrieved in computer from PubMed,EMbase,Cochrane Library,CBM,CNKI,Wanfang and VIP databases.The artificial supplementary retrieval was adopted to collect the important meeting set and issue information on CRS treated with Chinese herbal medicine from the library of Beijing University of Traditional Chinese Medicine.Two research fellows screened the articles and extracted the data independently and separately.Using RevMan 5.3,the Meta analysis was conducted.Results A total of 12 RCTs were collected,including 1011 cases of CRS.In the Meta analysis on the comparison between the integrated treatment with wenyang lishui yiqi huoxue method and Western medicine and the simple western medication for CSR,①Effective rate:OR=2.70[95%CI:(1.90,3.84)],indicating the statistical significant(Z=5.53,P<0.000 01);②BNP:MD=-30.32[95%CI:(-36.59,-24.04)],indicating the significant difference(Z=9.47,P<0.00001);③EF:SMD=0.52[95%CI:(0.23,0.80)],indicating the significant difference(Z=3.57,P=0.000 4<0.05);④Scr:SMD=-1.33[95%CI:(-2.11,-0.56)],indicating the significant difference(Z=3.37,P=0.000 7<0.05).Conclusion The integrated treatment with wenyang lishui yiqi huoxue method and Western medicine significantly improves the clinical effective rate on CRS and as well as the heart and kidney functions in the patients.The Chinese herbal medicines for warming yang,promoting water metabolism,benefiting qi and activating blood circulation,e.g.Astragalus,Poria cocos,Atractylodes,Monkshood,Semen lipidiiand and Miltiorrhiza should be used specifically in clinical practice.