真武汤治疗慢性肾脏病临床疗效的Meta分析

A Meta-analysis on Zhenwu decoction for Treating of Chronic Kidney Disease

目的:系统评价真武汤治疗慢性肾脏病的临床疗效。方法:计算机检索(检索时限:各数据库收录文献最早年限至2020年12月31日)中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Cochrane library、EMbase等数据库,查找真武汤治疗慢性肾脏病的随机对照试验(Randomized Controlled Trial,RCT),对符合纳入标准的文献进行数据提取,用Cochrane偏倚风险评估工具对纳入的文献进行偏倚风险评估,RevMan5.3软件进行Meta分析。结果:共纳入13项随机对照试验,共996例慢性肾脏病患者。Meta分析结果显示,试验组的临床总有效率[比值比=3.51,95%置信区间[2.38,5.18],P<0.001]、内生肌酐清除率(标准化均数差=1.28,95%置信区间[0.43,2.14],P=0.003)、血红蛋白(标准化均数差=1.85,95%置信区间[0.58,3.12],P=0.004)显著高于对照组,差异有统计学意义。试验组的血肌酐(标准化均数差=-0.99,95%CI[-1.50,-0.49],P<0.001)、血尿素氮(标准化均数差=-0.63,95%置信区间[-0.99,-0.27],P<0.001)、胱抑素-C(标准化均数差=-1.42,95%CI[-1.77,-1.07],P<0.001)、24 h尿蛋白定量(均数差=-0.65,95%置信区间[-1.29,-0.02],P=0.04)显著低于对照组,差异有统计学意义。结论:真武汤联合常规西医治疗能有效治疗慢性肾脏病,减少蛋白尿,降低血肌酐、尿素氮及胱抑素-C,改善贫血,减缓慢性肾脏病进展。但由于本研究纳入文献质量有限,仍需更多高质量、多中心的临床随机对照试验进一步验证。

Objective:To systematically evaluate the curative effect of Zhenwu decoction(真武汤)on chronic kidney disease.Methods:The data of randomized controlled trials about Zhenwu decoction for chronic kidney disease were retrieved from,CNKI,Wanfang Data,VIP,CBM,PubMed,Cochrane library and EMbase.The retrieval time was from the establishment time of database to december 312020.Data extraction was performed for the literature that met the inclusion criteria,quality evaluation with Cochrane System Evaluator Handbook 5.3,Meta-analysis was performed by using RevMan5.3.Results:There were 13 clinical randomized controlled trials included,involving 996 patients.The meta-analysis result showed that the effective rate(OR=3.51,95%CI[2.38,5.18],P<0.001),creatinineclearance rate(SMD=1.28,95%CI[0.43,2.14],P=0.003),hemoglobin(SMD=1.85,95%CI[0.58,3.12],P=0.004)in trial group were significantly higher than control group,serum creatinine(SMD=-0.99,95%CI[-1.50,-0.49],P<0.001),blood urea nitrogen(SMD=-0.63,95%CI[-0.99,-0.27],P<0.001),cystatin C(SMD=-1.42,95%CI[-1.77,-1.07],P<0.001)and 24 hour total urinary protein(MD=-0.65,95%CI[-1.29,-0.02],P=0.04)in trial group were significantly lower than control group,with statistical significance.Conclusion:The combination of Zhenwu decoction and Western medicine can effectively treat chronic kidney disease,reduce 24hTP,Scr,BUN and Cys-C,treat anemia,slow down chronic kidney disease progress.Because the quality of some trials included in the study is low.The above conclusions are expected to beverified by more high-quality multi-center randomized controlled trials with large samples.