活血化瘀类中药注射剂治疗高血压肾病的网状Meta分析

Network Meta-analysis of Huoxue Huayu Chinese medicine injections on hypertensive nephropathy

运用网状Meta分析的方法比较活血化瘀类中药注射剂治疗高血压肾病的疗效。计算机检索中国知网、万方、维普、SinoMed及PubMed、Cochrane Library、Web of Science数据库,检索时间为建库至2019年11月,收集干预措施涉及活血化瘀类中药注射剂、研究对象为高血压肾病患者的临床随机对照试验。由2位研究者独立筛选文献、提取资料和评价文献治疗后,采用RevMan 5.3,Stata 15.1,ADDIS 1.16.8软件进行数据分析。最终纳入50项RCTs 4 518例患者,涉及活血化瘀类中药注射剂5种。网状Meta分析结果显示:在肾功能保护方面,除注射用丹参多酚酸盐联合常规西药组外的中药注射剂联合常规西药组的尿蛋白定量、血肌酐均显著低于常规西药治疗组,银杏达莫注射液联合常规西药降低尿蛋白定量的效果最好,丹红注射液联合常规西药降低血肌酐的效果最好;在血压控制方面,除灯盏花素注射液联合常规西药组外的中药注射剂联合常规西药组的血压均显著低于常规西药治疗组,注射用丹参多酚酸盐联合常规西药降低血压的效果最好;安全性方面,所纳入研究均未发生严重不良反应。基于现有研究,所纳入的5种活血化瘀类中药注射剂联合常规西药对高血压肾病的疗效均显示出优势,银杏达莫注射液联合常规西药成为最优疗法的可能性最大。但受纳入文献数量和质量限制,该研究结论仍需更多高质量的多中心、大样本RCT予以验证。

To assess the clinical efficacy of Huoxue Huayu Chinese medicine injections on hypertensive nephropathy by using Network Meta-analysis method. The relative randomized controlled trials(RCTs) of Huoxue Huayu Chinese medicine injections on hypertensive nephropathy were retrieved from CNKI, WanFang, VIP, SinoMed, PubMed, Cochrane Library and Web of Science in November 2019. Two researchers independently conducted literature screening, data extraction and quality evaluation. The data was analyzed by RevMan 5.3, Stata 15.1, ADDIS 1.16.8 software. Finally, 4 518 patients in 50 RCTs were included, involving 5 kinds of Huoxue Huayu Chinese medicine injections. The five Chinese medicine injections were Breviscapine Injection, Danhong Injection, Sodium Tanshinone Ⅱ_A Sulfonate Injection, Ginkgo Dipyridamole Injection, and Salvianolate Injection. Meta-analysis showed that, in terms of renal function protection, urine protein quantification and serum creatinine of each Chinese medicine injections combined with conventional Western medicine group, except Salvianolate Injection combined with conventional Western medicine group, was significantly lower than those of the conventional Western medicine treatment group. Ginkgo Dipyridamole Injection combined with conventional Western medicine had the best effect in reducing urine protein, and Danhong Injection combined with conventional Western medicine had the best effect in reducing serum creatinine. In terms of blood pressure control, the blood pressure of each Chinese medicine injections combined with conventional Western medicine group, except Breviscapine Injection combined with conventional Western medicine group, was significantly lower than that of conventional Western medicine treatment group. Salvianolate Injection combined with conventional Western medicine had the best effect in reducing blood pressure. In terms of safety, no serious adverse reactions were found in all studies. The five kinds of Huoxue Huayu Chinese medicine injections combined with conventional Western medicine had significantly advantages in the treatment of hypertensive nephropathy. Ginkgo Dipyridamole Injection combined with conventional Western medicine is most likely to be the optimal therapy. However, limited by the quantity and quality of the documents included, the conclusion of this study still needs to be verified by more high-quality, multi-center and large-sample RCT.