中医外治法保护血液透析动静脉内瘘疗效评价与用药分析的系统评价

Therapeutic Effect of External Treatment of Traditional Chinese Medicine on Protecting Arteriovenous Fistula in Hemodialysis and Systematic Review of Medication Analysis

目的:系统评价中医外治法干预血液透析用动静脉内瘘的疗效与安全性,分析用药规律。方法:检索中文核心期刊、PubMed、Cochrane随机对照试验数据库,收集中医外治法干预动静脉内瘘的随机对照试验,采用Stata 14.0对结局指标(内瘘血栓、内瘘狭窄、内瘘血流量、不良反应)Meta分析;通过频数分析和因子分析探索处方规律。结果:共纳入18篇文献、1410例患者。Meta分析结果:与常规治疗比较,中药外治法减少内瘘血栓及内瘘狭窄发生率[RR=0.25,95%CI(0.15,0.42);RR=0.37,95%CI(0.26,0.51)],提高血流量[SMD=1.28,95%CI(1.94,3.85)],不良反应无增加[RR=0.70,95%CI(0.21,2.34)];亚组分析提示中药熏洗对内瘘狭窄及血流量疗效与对照组比较差异无统计学意义;敏感性分析均阴性,但存在发表偏倚。频数分析表明常用中药为活血化瘀类、疏筋通络类和清热解毒类药物,频次最高依次为红花(14.29%)、当归(12.70%)、桂枝(7.94%)、川芎(7.94%)。结论:中医外治法,尤其外敷治疗,可减少动静脉内瘘血栓和狭窄发生率、提升内瘘血流量,不良反应少,但可能存在潜在阴性结果未发表,因此有待进一步临床验证;临床药物配伍以活血化瘀、舒筋活络和清热解毒药为主。

Objective:To assess the efficacy and safety,and analyse medication rules of external treatment of Traditional Chinese medicine(TCM)for arteriovenous fistula(AVF)in patients receiving hemodialysis.Methods:A systematic search was used to identify randomized controlled trials evaluating the effect of external therapy of TCM for AVF.The outcomes of thrombosis,stenosis,and blood flow of AVF and adverse reactions were analyzed by meta-analysis with stata 14.0.The compatibility of prescription was explored by frequency analysis and factor analysis.Results:18 studies and 1410 patients were enrolled.Compared to control group,TCM alone or combined treatment had superiority in preventing fistula thrombosis and stenosis rates[RR=0.25,95%CI(0.15,0.42);RR=0.37,95%CI(0.26,0.51)],and increasing fistula blood flow[SMD=1.28,95%CI(1.94,3.85)];in addition,no significant adverse events were observed.Subgroup analysis showed that there were no significant differences in the methods of fumigating and washing on stenosis and blood flow of AVF when compared with the control group.Sensitivity analysis was stable,however,publication bias might exist.The commonly used herbals were blood activating and stasis removing,muscle dredging and collaterals clearing,and detoxification clearing drugs,the highest frequency were Honghua(14.29%),Danggui(12.70%),Guizhi(7.94%),Chuanxiong(7.94%).Conclusion:External treatments of TCM could reduce the risks of thrombosis and stenosis of AVF,improve the blood flow of fistula,with no significant adverse reactions;however,considering potential negative results,further clinical verification is needed.The commonly used drugs were composed with activating blood and removing stasis,relaxing muscles and activating collaterals,clearing heat and detoxifying herbals.