造影剂肾病中西医结合预防的meta分析

发布时间：2018-09-07 16:41

【摘要】：目的:系统评价中西医结合预防造影剂肾病的临床有效性及安全性,以期为临床预防造影剂肾病提供相关循证依据。材料与方法:按照Cochrane系统评价的步骤(即1.提出问题;2.确定和选择原始研究报告;3.对原始研究报告进行评价;4.收集数据;5.对研究结果进行分析和报告;6.解释结果;7.改进和更新原有评价)严格制定详细的纳入标准与排除标准等。计算机检索相关期刊论文、中文科技期刊全文数据库、万方数据库、重庆维普数据库、中国生物医学文献数据库、中国科学引文数据库等收集自2008-2017年中西医结合(治疗组)相比其他方式(对照组)预防造影剂肾病(CIN)的随机对照试验(RCT),两名研究者独立评估检索的文章中使用的纳入标准和排除标准,并分别评价文献质量,提取资料后再进行相互核对,采用Rev Man 5.3统计软件进行Meta分析。评价指标:CIN发病率、血清肌酐值(Scr)、不良反应发生情况。结果:共纳入23项RCT,合计2738例,中西医结合治疗组1375例,对照组1363例,与对照组相比较,(1)23篇文献比较了中西医结合用药与对照组用药预防造影剂肾病的发生率:各研究间无统计学异质性(P=1.00,I2=0%),应用固定效应模型进行分析。Meta分析结果显示,[RR=0.25,95%CI(0.19,0.34),P0.00001],两组临床疗效有效率差别具有统计学意义,提示中西医结合预防造影剂肾病的发病率明显优于对照组,可降低CIN发病率。(2)23项研究报道了使用造影后1-7天的平均血清肌酐值,选取平均血清肌酐的最高值做meta分析研究,各研究间有统计学异质性(P0.00001,I2=78%),采用随机效应模型分析。Meta分析结果显示,[MD=-11.24,95%CI(-12.76,-9.72),P0.00001],差异有统计学意义。提示患者经过中西医结合药物治疗后,治疗组平均血清肌酐值要明显低于对照组。(3)15项研究对对照组和治疗组用药后的不良反应发生情况进行了说明,各研究间无统计学异质性(P=1.00,I2=0%),采用固定效应模型分析。Meta分析结果显示,[OR=0.22,95%CI(0.10,0.49),P=0.0002],差异统计学意义,提示中西医结合药物预防造影剂肾病,临床中不良反应发生情况较西医组少。结论:中西医结合预防造影剂肾病的发生、降低造影后血清肌酐值均明显优于对照组,发生不良反应情况较对照组明显减少。本研究纳入文献有限,临床中,尚需更多质量更高的随机对照试验予以证实。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of integrated traditional Chinese and western medicine in the prevention of contrast agent nephropathy, and to provide evidence-based evidence for clinical prevention of contrast agent nephropathy. Materials and methods: according to the steps of Cochrane system evaluation (I. E. 1. Ask questions. Identify and select the original research report. The original research report was evaluated. Collect data. Analysis and report on the results of the study. Explain the result. Improve and update the original evaluation) strict formulation of detailed inclusion criteria and exclusion criteria. Computer Retrieval of full text Database of Chinese Journals, full text Database of Chinese Sci-tech Journals, Wanfang Database, Chongqing Weipu Database, Chinese Biomedical Literature Database, Chinese scientific citation database collected from 2008-2017 integrated Chinese and western medicine (treatment group) compared with other methods (control group) for the prevention of contrast agent nephropathy (CIN) randomized controlled trial (RCT), two researchers independently evaluated the retrieval of the articles used Inclusion and exclusion criteria, The quality of literature was evaluated, and the data were extracted and cross-checked. Meta analysis was carried out with Rev Man 5.3 software. Outcome measure: incidence of (Scr), and incidence of serum creatinine. Results: a total of 2738 cases were included in 23 items of RCT, 1375 cases in the treatment group and 1363 cases in the control group. Compared with the control group, (1) 23 articles compared the incidence of contrast agent nephropathy between the combination of traditional Chinese and western medicine and the control group: there was no statistical heterogeneity among the studies (P0. 00%). The fixed effect model was used to analyze. Meta-analysis results showed that there was no statistical heterogeneity between the two groups. , [RR=0.25,95%CI (0.19 ~ 0.34) P 0.00001], the difference of effective rate between the two groups was statistically significant. It was suggested that the incidence of contrast agent nephropathy was significantly higher than that of the control group. (2) 23 studies reported using the mean serum creatinine value 1-7 days after angiography, and selecting the highest mean serum creatinine value for meta analysis. There was statistical heterogeneity (P0.00001). The results of random effect model analysis. Meta-analysis showed that [MD=-11.24,95%CI (-12.76-9.72)] P0.00001, the difference was statistically significant. It was suggested that the mean serum creatinine level in the treatment group was significantly lower than that in the control group after the treatment of integrated Chinese and western medicine. (3) the adverse reactions of the control group and the treatment group were explained in 15 studies. There was no statistical heterogeneity (P < 1.00). The results of fixed effect model analysis. Meta-analysis showed that [OR=0.22,95%CI (0.100.49) / P 0.0002], the difference was statistically significant, suggesting that integrated Chinese and western medicine can prevent contrast agent nephropathy, and the incidence of adverse reactions in clinical is less than that in western medicine group. Conclusion: the combination of traditional Chinese and western medicine can prevent the occurrence of contrast agent nephropathy, and decrease the serum creatinine level after contrast, and the incidence of adverse reactions is obviously lower than that in the control group. This study is limited in literature and needs to be confirmed by more quality and higher-quality randomized controlled trials in clinical practice.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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