中医药治疗慢性肾功能不全的回顾性分析

发布时间：2018-04-17 06:46

本文选题：慢性肾功能不全 + 中医药　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:通过系统回顾中医药治疗慢性肾功能不全的随机对照试验相关文献,评价中医药对中晚期患者疾病进展的有效性及安全性,在此基础上通过临床回顾性观察,进一步探索中医药对患者进入透析结局的影响,筛选影响透析结局发生的相关因素。方法:检索2006年1月1日至2015年12月31日10年间相关期刊论文(CNKI)、中国科技期刊数据库(VIP)、中国生物医学期刊数据库(CBM)、万方学位论文数据库四个中文数据库以及PubMed、EMBASE、Cochrane Library英文数据库中中医治疗慢性肾功能不全的随机对照试验,系统评价中药治疗的有效性及安全性,使用Review Manager 5.3软件进行Meta分析。采用回顾性-队列研究,筛选中日友好医院2012年1月1日至2015年12月31日出院主诊断为慢性肾脏病中晚期(CKD4-5期)未进入透析的病人,记录患者基本特征、临床检验指标、用药信息并且随访患者预后情况,对透析结局发生情况进行统计分析。最后运用COX回归模型分析筛选影响透析结局发生的危险因素。结果:(1)文献研究共检索到相关文献721篇,最终纳入11篇文献进行meta分析,结果显示中药可能对慢性肾功能不全患者症状、体征以及肾小球滤过率的改善,血肌酐、血尿素氮、24小时尿蛋白定量的降低具有一定的作用;对于安全性指标及不良反应的报告相对较少,尚不能评价中药治疗的安全性;缺乏针对疾病进展的终点结局事件发生的研究,亟待进一步的临床研究评估中药治疗慢性肾脏病的远期疗效;(2)临床研究根据纳排标准共筛选出CKD4-5期患者120例,以中药干预治疗做为暴露因素分为干预组(中西医治疗)47例,非干预组(西医治疗)73例进行为期1年的访视观察,进入透析结局患者49例,其中干预组12例进入透析,透析率为25.53%,非干预组进入透析人数为37人,透析率为50.68%,相对危险度RR=0.501,提示中药治疗是影响进入透析的保护因素。进入透析与未进入透析患者相比,两组的中药使用情况、糖尿病并发症、年龄、C02结合力以及高磷、低钙、贫血情况均具有显著差异(P0.05),将以上具有统计学意义的变量逐步引入COX多因素回归模型中,结果显示中药干预是透析结局发生的保护因素,贫血、糖尿病并发症与高磷、低钙体征是影响透析结局的独立危险因素。结论:(1)中医药可以提高慢性肾功能不全的治疗疗效,延缓透析结局的发生,但仍需今后大样本、多中心、前瞻性随机对照试验来进一步证实中医药可以延缓慢性肾脏病的进展。(2)中药干预措施是影响进入透析结局的保护性因素,高磷、低钙、高血糖、贫血症状体征是影响透析结局的独立危险因素,因此积极使用中医中药进行干预,同时监控改善患者血红蛋白、血糖、钙磷指标是预防CKD进展的有效措施。
[Abstract]:Objective: to evaluate the efficacy and safety of traditional Chinese medicine (TCM) in the treatment of chronic renal insufficiency (CRD) by reviewing the literature of randomized controlled trials on the treatment of chronic renal insufficiency (CRD), and to evaluate the efficacy and safety of TCM in the progression of middle and late stage diseases.To further explore the impact of Chinese medicine on the outcome of dialysis patients into dialysis, screening the relevant factors affecting the outcome of dialysis.Methods: four Chinese databases, CNKI, VIPI, CBMN, CBMN, and Wanfang thesis database, were searched from January 1, 2006 to December 31, 2015, and from January 1, 2006 to December 31, 2015.And a randomized controlled trial on the treatment of chronic renal dysfunction with traditional Chinese medicine (TCM) in the PubMedus EMBASE Cochrane Library English database,The efficacy and safety of traditional Chinese medicine were systematically evaluated and Meta analysis was performed with Review Manager 5.3 software.A retrospective cohort study was used to screen the patients who were not undergoing dialysis in China-Japan Friendship Hospital from January 1, 2012 to December 31, 2015.Medication information and prognosis of the patients were followed up and the outcome of dialysis was statistically analyzed.Finally, COX regression model was used to analyze and screen the risk factors affecting dialysis outcome.Results (1) A total of 721 related papers were retrieved and 11 papers were included in the study for meta analysis. The results showed that Chinese herbal medicine might improve the symptoms, signs and glomerular filtration rate of patients with chronic renal insufficiency, and serum creatinine.The quantitative reduction of urinary protein in 24 hours of blood urea nitrogen has a certain effect, and the safety index and adverse reactions are relatively few, so it is not possible to evaluate the safety of traditional Chinese medicine treatment.There is a lack of research on the outcome events of disease progression. It is urgent for further clinical research to evaluate the long-term efficacy of traditional Chinese medicine in the treatment of chronic kidney disease.According to the Chinese medicine intervention therapy as the exposure factor, the intervention group was divided into two groups: the intervention group (47 cases) and the non-intervention group (73 cases) for a period of one year, 49 patients entered the dialysis outcome, among which 12 cases in the intervention group entered dialysis.The dialysis rate was 25.53, the number of people in the non-intervention group was 37, the dialysis rate was 50.68, and the relative risk was RRR0.501, suggesting that the treatment of Chinese medicine was the protective factor affecting the entry into dialysis.Compared with the patients without dialysis, the two groups were treated with traditional Chinese medicine, diabetes complications, age C02 binding capacity, high phosphorus, low calcium,There were significant differences in anemia (P 0.05). The above statistical variables were gradually introduced into COX multivariate regression model. The results showed that Chinese medicine intervention was the protective factor of dialysis outcome, anemia, diabetic complications and high phosphorus.Hypocalcemia is an independent risk factor for dialysis outcomes.Conclusion 1) traditional Chinese medicine can improve the therapeutic effect of chronic renal insufficiency and delay the occurrence of dialysis outcome, but it still needs a large sample and multi-center in the future.Prospective randomized controlled trials to further confirm that Chinese medicine can delay the progression of chronic kidney disease.) Chinese medicine intervention is a protective factor that affects the outcome of dialysis, high phosphorus, low calcium, high blood sugar,The symptoms and signs of anemia are independent risk factors affecting the outcome of hemodialysis, so it is an effective measure to prevent the progress of CKD by actively using Chinese medicine to intervene and to monitor and improve the hemoglobin, blood glucose and calcium and phosphorus index of patients.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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