大黄附子汤及其不同给药途径对慢性肾功能衰竭疗效的系统评价

Modified Dahuang Fuzi decoction and its different administration methods for chronic renal failure:a systematic review

目的探究大黄附子汤及其不同给药方式治疗慢性肾衰的临床疗效。方法中文检索,以"大黄附子汤,慢性肾功能衰竭"为检索词检索中国知网、万方数据库、维普网中文科技数据库、中国生物医学文献数据库。外文检索,以"Dahuang Fuzi decoction,Chronic renal failure,CRF"为检索词,检索Pubmed、Embase、The Cochrane Library等数据库。检索时间均为建库至2020年5月10日。依据纳入及排除标准,排除明显不符合的文献后,下载相关文献并仔细阅读全文,排除资料不完整、文献重复、非随机对照试验(RCT)研究的文献,并对剩余文献进行数据提取。采用RevMan 5.3软件进行Meta分析。将大黄附子汤根据用药途径不同分为灌肠组、结肠透析组和口服组,并对某些可能影响总体实验结果的指标进行亚组分析。结果共纳入17个RCT,包括1159例病人。Meta分析结果:治疗组总有效率优于对照组(OR=5.35,95%CI:3.53~8.09);在减少尿素氮方面,灌肠和口服组均优于对照组,结肠透析组差异无统计学意义。在其他方面(血肌酐MD=-61.97,95%CI:-69.23~-54.71、肌酐清除率MD=6.25,95%CI:4.69~7.82)治疗组均优于对照组。两组不良反应差异无统计学意义(OR=1.01,95%CI:0.33~3.15)。结论在常规西医治疗基础上给予大黄附子汤治疗较单纯西医常规治疗可显著提高慢性肾衰竭病人治疗疗效。但由于纳入研究质量和数量问题,今后仍需要更多大样本、高质量的RCT研究进行验证。

Objective To explore the clinical efficacy of Dahuang Fuzi Decoction and its different administration methods in the treatment of chronic renal failure.Methods Chinese search,using"Dahuang Fuzi Decoction,Chronic Renal Failure"as the search term to search China HowNet,Wanfang Database,Weipu Net Chinese Science and Technology Database,and China Biomedical Literature Database.The foreign language search,with"Dahuang Fuzi decoction,Chronic renal failure,CRF"as the search term,the pubmed,Embase,The Cochrane Library and other databases,the search time is the construction of the database-2020 May 10th According to the inclusion and exclusion criteria,after excluding documents that are obviously inconsistent,download the relevant documents and read the full text carefully,exclude documents with incomplete data,duplicate documents,and non-RCT research,and extract data from the remaining documents.RevMan 5.3 software was used for meta analysis.Dahuang Fuzi Decoction was divided into enema group,colon dialysis group and oral group according to the different route of medication,and some indicators that might affect the overall experimental results were analyzed by subgroups.Results A total of 17 RCTs were included,including 1159 patients.Meta analysis results show that:in terms of total effective rate:the total effective rate of the treatment group is better than the control group(OR=5.35,95%CI:3.53-8.09);in terms of reducing urea nitrogen,the enema and oral groups are better than the control group There was no significant difference in colon dialysis group.In other aspects(serum creatinine MD=-61.97,95%CI:-69.23--54.71),creatinine clearance rate MD=6.25,95%CI:4.69-7.82)the treatment group was better than the control group.In terms of adverse reactions,the two groups had no significant statistical significance.Conclusion The treatment of Dahuang Fuzi Decoction on the basis of conventional Western medicine can significantly improve the therapeutic effect of patients with chronic renal failure compared with conventional Western medicine.However,due to the quality and quantity of the included studies,more large-sample,high-quality RCT studies are still needed for verification in the future.