药用炭治疗慢性肾脏疾病的系统评价

目的系统评价药用炭治疗慢性肾脏疾病的疗效和安全性。方法按照国际Cochrane协作网的系统评价方法，检索Cochrane图书馆临床对照试验数据库（2009年第l期）、MEDLINE（1950，2009年1月）、EMbase（1980～2009年1月），中国生物医学文献数据库（1977～2009年1月）和中国期刊全文数据库（1994～2009年1月），纳入所有药用炭治疗慢性肾脏疾病的随机对照试验：根据Cochrane系统评价员手册4．2．2版评估纳入试验的偏倚风险，应用RevMan 5．0软件进行统计分析。结果共纳入7个研究，包括347例患者。Meta分析结果显示：①经药用炭治疗后，患者血清尿素氮[SMD=-0．69，95％CI（-1．13，-0．24），P=0．002]、血清肌酐[SMD=-0．51，95％CI（-0．94，-0．08），P=0．02]和肾小球滤过率月变化量（P〈0．001）改善优于常规治疗；但24h尿蛋白定量和平均血压的改善未见优于常规治疗；②与安慰剂比较，治疗后终末期肾病发生率、廊清肌酐、24h尿蛋白定量和内生肌酐清除率的改善不优于安慰剂（P〉0．05）;③不良反应主要有便秘、恶心和腹胀，且大多症状轻微。结论由于纳入试验较少，目前的证据尚不能对药用炭治疗慢性肾脏疾病的有效性及安全性做出肯定的评价，还需开展更多大样本、高质量的随机对照试验进一步证实.

Medicinal Charcoal for Chronic Kidney Disease: A Systematic Review

Objective To assess the efficacy and safety of prescribing medicinal charcoal for treatment of adult chronic kidney disease. Methods We searched the Cochrane Controlled Trial Register (The Cochrane Library Issue 1,2009), MEDLINE (1950 to January 2009), EMbase (1980 to January 2009), and Chinese Biomedical Database (1977 to January 2009) to screen randomized controlled trials (RCTs) concerning use of medicinal charcoal for treatment of adult chronic kidney disease. We evaluated the bias risk of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 4.2.2.The Cochrane Collaboration's software RevMan 5.0 was used for meta-analysis.Results Seven trials involving 347 patients met the criteria. Meta-analysis showed: (1) Medicinal charcoal was better than routine treatment on the improvement of blood urea nitrogen [MD= -0.69, 95%CI (-1.13, -0.24), P=0.002], serum creatinine [MD= - 0.51, 95%CI (-0.94, - 0.08), P=0.02] and the mean change of glomerular filtration rate per month (P<0.001). Compared with routine treatment, medicinal charcoal had similar effects on the improvement of 24 hours urinary protein and the mean change of blood pressure; (2) Compared with placebo, and medicinal charcoal was not superior to placebo in improving the incidence of end stage kidney diseases, serum creatinine, creatinine clearance rate, 24 hour urinary protein (P>0.05); (3) Adverse events with constipation, flatulenceand nausea occurred to medicinal charcoal groups. Conclusion Overall, the evidence is not strong enough, and more large, high-quality randomized controlled trials are needed to confirm or refute the available evidence.