调补脾肾中药治疗慢性尿酸性肾病的系统评价

Regulating and tonifying spleen and kidney traditional Chinese medicine in the treatment of chronic uric acid nephropathy:A systematic review

目的:评估调补脾肾中药治疗慢性尿酸性肾病的有效性和安全性。方法:检索中国知网数据库、维普全文数据库、万方数据知识服务平台、中国生物医学文献数据库、PubMed、Embase数据库中运用调补脾肾中药联合西医常规治疗慢性尿酸性肾病且结局指标含有效率的随机对照研究,检索时间为建库之日至2020年6月30日。用Cochrane协作网风险偏倚评估工具进行文献方法学质量评价,并按照GRADE标准进行证据等级评价。定量数据采用RevMan5.3软件进行数据分析,对有效率进行试验序贯分析。结果:纳入10篇文献,总病例数709例。Meta分析结果示:与对照组相比,调补脾肾中药能提高有效率[RR=1.45,95%CI(1.32,1.58)],降低血清尿酸(UA)[MD=−36.24,95%CI(−41.03,−31.45)]、血清尿素氮(BUN)[SMD=−1.27,95%CI(−1.47,−1.07)]和血肌酐(Scr)[MD=−36.33,95%CI(−55.79,−16.87),P=0.0003],差异具有统计学意义(P<0.05),且无证据表明有明显不良反应发生。TSA分析结果示:在提高有效率方面证据确切。根据GRADE评价标准,有效率及降低UA、BUN和Scr指标均为极低质量证据。结论:调补脾肾中药治疗慢性尿酸性肾病,能提高治疗有效率,降低UA、BUN、Scr,安全性良好,但仍需较高质量证据支持。

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine for regulating spleen and kidney.Methods:We developed a search strategy and then retrieved the database including CNKI,Wanfang data knowledge service platform,VIP journals resource integration service platform,PubMed,and Embase for randomized controlled trial of regulating spleen and kidney traditional Chinese medicine compared with conventional western medicine in the treatment of chronic uric acid nephropathy.The search deadline was set to June 30,2020.For the included literature,we applied the Cochrane collaboration network risk bias assessment tool to evaluate the methodological quality,and evaluated the level of evidence accord-ing to GRADE standards.Quantitative data were analyzed by RevMan5.3 software,and trial sequential analysis method was used to analyze its efficiency.Results:A total of 709 cases in 10 articles were included.Compared with the control group,the related traditional Chinese medicine group improved the effective rate[RR=1.45,95%CI(1.32,1.58)],reduced the level of UA[MD=36.24,95%CI(−41.03,−31.45)],BUN[SMD=−1.27,95%CI(−1.47,−1.07)]and SCR[MD=−36.33,95%CI(−55.79,−16.87),P=0.0003],and the difference between the two groups was statistically significant(P<0.05).There was no evidence that a significant adverse reaction occurred.The results of TSA analysis showed that the Chinese medicine group had definite evidence for improving the efficiency.According to the GRADE evaluation criteria,the efficiency,UA,BUN and SCR outcome indicators were extremely low-quality evidence.Conclusion:Traditional Chinese medicine for regulating spleen and kid-ney in the treatment of chronic uric acid nephropathy improves efficiency,and reduces the level of UA,BUN,SCR.Meanwhile,the therapy is proved to be safe.Nevertheless,the conclusions need further high-quality evidence to support.