结肠透析联合中药灌肠治疗慢性肾脏病3-5期临床疗效系统评价

A Systematic Review of the Clinical Efficacy of Colon Dialysis Combined with Traditional Chinese Medicine Enema in the Treatment of Chronic Kidney Disease Stage 3-5

目的:系统评价结肠透析联合中药灌肠治疗慢性肾脏病(Chronic kidney disease,CKD)3-5期的有效性及安全性。方法:检索近5年来中国知网总库(CKNI)、万方数据库、维普数据库(VIP)、pubmed等相关数据库中发表的有关结肠透析联合中药灌肠治疗CKD临床随机对照试验(RCT)的文献,采用Cochrane协作网开发的评价策略对纳入文献的质量和风险偏倚进行评价,利用RevMan 5.3软件进行Meta分析并绘制倒漏斗图。结果:最终纳入16篇相关文献,均为中文文献。Meta分析结果显示,结肠透析联合中药灌肠能提高CKD患者临床有效率(OR=0.31,95%CI=[0.22,0.44],P<0.00001),降低血肌酐(Serum creatinine,Scr)(MD=49.65,95%CI=[42.70,56.60],P<0.00001)、提高内生肌酐清除率(Endogenous creatinine clearance,Ccr)(MD=-4.74,95%CI=[-5.22,-3.96],P<0.00001)及估算肾小球滤过率(Estimate the glomerular filtration rate,eGFR)(MD=-4.58,95%CI=[-6.16,-3.00],P<0.00001)。结论:结肠透析联合中药灌肠比单纯西医治疗CKD3-5期更有优势。然而因为本次研究所纳入的文献样本数量有限,且在分组隐藏、盲法、随访等方面存在缺陷,仍需开展高质量的大样本、多中心的RTC试验来对结果进一步验证。

Objective:To systematically evaluate the effectiveness and safety of colon dialysis combined with traditional Chinese medicine enema in the treatment of chronic kidney disease(CKD)stages 3-5.Methods:Retrieved the literature on clinical randomized controlled trials(RCT)of colon dialysis combined with traditional Chinese medicine enema in the treatment of CKD published in related databases such as China National Knowledge Network(CKNI),Wanfang database,VIP database(VIP),and pubmed in the past 5 years.The evaluation strategy developed by the Cochrane Collaboration was used to evaluate the quality and risk bias of the included literature,and the RevMan 5.3 software was used for Meta analysis and an inverted funnel chart was drawn.Results:Finally,16 relevant documents were included,all of which were in Chinese.Meta-analysis results show that colon dialysis combined with traditional Chinese medicine enema can increase the clinical effectiveness of CKD patients(OR=0.31,95%CI=[0.22,0.44],P<0.00001),and reduce serum creatinine(Serum creatinine,Scr)(MD=49.65),95%CI=[42.70,56.60],P<0.00001),improve Endogenous creatinine clearance(Ccr)(MD=-4.74,95%CI=[-5.22,-3.96],P<0.00001)And Estimate the glomerular filtration rate(eGFR)(MD=-4.58,95%CI=[-6.16,-3.00],P<0.00001).Conclusion:Colon dialysis combined with traditional Chinese medicine enema has more advantages than Western medicine alone in the treatment of CKD3-5 stage.However,due to the limited number of literature samples included in this study,and defects in group hiding,blinding,and follow-up,it is still necessary to carry out high-quality large-sample,multi-center RTC trials to further verify the results.