补肾活血法联合血液透析治疗慢性肾衰竭的Meta分析

Meta-analysis of kidney tonifying and blood activating therapy combined with hemodialysis in the treatment of chronic renal failure

关键词:  补肾活血法  血液透析  慢性肾衰竭  Meta分析  试验序贯分析

Key words:  tonifying kidney and promoting blood circulation method  hemodialysis  chronic renal failure  Meta-analysis  trial sequential analysis

摘要:

[目的]对补肾活血法联合血液透析治疗慢性肾衰竭的文献进行Meta分析。[方法]计算机检索中国期刊全文数据库(CNKI)、万方数据库知识服务平台(WangFang)、Pubmed、EmBase等数据库,筛选补肾活血法联合血液透析治疗慢性肾功能不全的随机对照试验,检索时间为自建库起至2022年9月7日。运用Cochrane风险偏倚评估工具进行文献质量评价,应用Review Manager 5.3软件进行Meta分析,使用Stata14.0软件进行Egger检验,以评估发表偏倚,若存在发表偏倚则进一步运用非参数剪补法评估偏倚对结果的影响。运用GRADEprofiler3.6软件对本研究涉及结局指标进行证据质量评价。[结果]纳入14篇相关研究文献,共1 316例患者,试验组660例,对照组656例。Meta分析结果显示,补肾活血法联合血液透析在降低血肌酐(Scr)、尿素氮(BUN)水平、中医证候积分方面优于单纯血液透析组,提高肌酐清除率(Ccr)、有效率方面联合组优于单纯血液透析组,差异具有统计学意义,但证据质量有待提高。两组的不良反应发生率未见统计学差异。发表偏倚检验及非参数剪布法结果提示血Scr、BUN指标存在偏倚,但偏倚结果对结果未造成影响。[结论]研究证明补肾活血法联合血液透析治疗慢性肾衰竭疗效显著,可以降低Scr、BUN、中医证候积分,提高Ccr水平,且未见不良反应增加。但需要更多高质量、大规模的研究来进一步验证。

Abstract:

[Objective] To conduct a meta-analysis of the literature on the combination of hemodialysis with kidney tonification and blood activation method for the treatment of chronic renal failure. [Methods] Computer searched of CNKI,WangFang,Pubmed,Embase and other databases to screen randomized controlled trials of tonic kidney and blood activation method combined with hemodialysis for the treatment of chronic renal insufficiency from the time of database creation to September 7,2022. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the literature,and meta-analysis was performed using Review Manager 5.3 software,and Egger test was performed using Stata 14.0 software to assess publication bias,if publication bias exists,nonparametric cut and fill method is further used to evaluate the impact of bias on the results. Evidence quality evaluation of this study involving outcome indicators used GRADEprofiler 3.6 software. [Results] Fourteen relevant studies with a total of 1 316 patients,660 in the test group and 656 in the control group,were included in the literature. Meta-analysis results showed that tonifying kidney and promoting blood circulation method combined with hemodialysis was better than the simple hemodialysis group in reducing blood creatinine and urea nitrogen levels and traditional Chinese medicine(TCM) evidence score,and the combination group was better than the simple hemodialysis group in improving creatinine clearance and efficiency,and the difference was statistically significant,but the quality of evidence needs to be improved. No significant difference was seen in the incidence of adverse reactions between the two groups. The results of the publication bias test and nonparametric clipping method suggested bias in blood creatinine and urea nitrogen indicators,but the biased results did not affect the results. [Conclusion] This study demonstrated that the combination of tonifying kidney and promoting blood circulation method with hemodialysis was effective in the treatment of chronic renal failure,which could reduce Scr,BUN,TCM evidence score and improve Ccr level,and no increase in adverse effects. However,more high-quality,large-scale studies are needed for further validation.