中药注射液治疗慢性肾功能不全的贝叶斯网状Meta分析

采用网状Meta分析方法,以西医常规治疗为共同参照,对比红花注射液、丹参注射液、肾康注射液、疏血通注射液、路路通注射液、参芎葡萄糖注射液、川芎注射液对慢性肾功能不全的临床疗效。计算机检索有关红花注射液、丹参注射液、肾康注射液、疏血通注射液、路路通注射液、参芎葡萄糖注射液、川芎注射液治疗慢性肾功能不全的随机对照试验。由2位评价者独立筛选,纳入文献后使用Cochrane Reviewer′s Handbook 5.1方法进行文献质量评价。运用RevMan 5.3、GEMTC软件、R软件的RJAGS包、GEMTC包进行统计分析,比较不同注射液的疗效差异,并进行排序。最终纳入79个RCTs,6197例慢性肾功能不全患者,涉及8种治疗措施。与常规治疗相比,联合参芎注射液(OR=3.55,95%CI1.98,6.37],P<0.0001)、联合红花注射液(OR=3.77,95%CI2.45,5.81],P<0.00001)、联合疏血通注射液(OR=6.71,95%CI3.30,13.65],P<0.00001)、联合肾康注射液(OR=4.14,95%CI3.42,5.03],P<0.00001)的有效率均优于对照组,红花注射液联合常规治疗的有效率优于丹参注射液联合常规治疗(OR=3.89,95%CI1.73,8.74],P=0.001),差异均有统计学意义。综合对比,疏血通注射液、红花注射液、肾康注射液联合西医常规治疗对慢性肾功能不全的有效率、血清肌酐降低情况、尿素氮降低情况均有较好的临床疗效。但由于纳入文献质量相对偏低,得出的结论尚有待临床验证。

Bayesian network Meta-analysis of Chinese medicine injections in treatment of chronic renal insufficiency

In this study,Honghua Injection,Danshen Injection,Shenkang Injection,Shuxuetong Injection,Lulutong Injection,Shenxiong Glucose Injection and Chuanxiong Injection were compared for their clinical efficacy on chronic renal insufficiency by using the method of network Meta-analysis,with Western medicine as the common reference.The randomized controlled trial(RCT)of Hong-hua Injection,Danshen Injection,Shenkang Injection,Shuxuetong Injection,Lulutong Injection,Shenxiong Glucose Injection and Chuanxiong Injection for the treatment of chronic renal insufficiency were obtained by computer-based retrieval.The literature quality was evaluated by using the method in Cochrane Reviewer′s Handbook 5.1 after independent screening of the included literature by two reviewers.The RJAGS package and GEMTC package of RevMan 5.3,GEMTC software,R software were used for statistical analysis to compare and sort the different injections in terms of efficacy.A total of 6197 patients with chronic renal failure were included in 79 RCTs,involving 8 treatment measures.The effective rates of conventional treatment combined with Shenxiong Injection(OR=3.55,95%CI1.98,6.37],P<0.0001),Honghua Injection(OR=3.77,95%CI2.45,5.81],P<0.00001),Shuxuetong Injection(OR=6.71,95%CI3.30,13.65],P<0.00001)and Shenkang Injection(OR=4.14,95%CI3.42,5.03],P<0.00001)were all better than that in control group,and the effective rate of Honghua Injection combined with conventional treatment(OR=3.89,95%CI1.73,8.74],P=0.001)was better than that in Danshen Injection combined with conventional treatment,all with statistically significant differences.By comprehensive comparison,Shuxuetong Injection,Honghua Injection and Shenkang Injection combined with Western medicine had good clinical effect on the effective rate,serum creatinine reduction and urea nitrogen reduction in patients with chronic renal insufficiency.However,due to the relatively low quality of the included literature,the conclusion has yet to be verified clinically.