中医药联合常规疗法治疗肾性骨病Meta分析

目的:系统评价中医药联合常规疗法治疗肾性骨病的临床疗效及其安全性。方法:计算机检索中国知网、万方期刊数据库、PubMed及Cochrane Central等数据库,检索中医药治疗肾性骨病的随机对照试验(randomized controlled trial,RCT),采用RevMan 5.3软件进行Meta分析。结果:共纳入24篇RCT,共1552例肾性骨病患者。Meta分析结果表明:中医药联合常规疗法与常规治疗的有效率比较,差异有统计学意义RR=1.30,95%CI(1.18,1.44),P<0.00001],亚组分析显示,补肾活血法的临床疗效最好RR=1.47,95%CI(1.30,1.67),P<0.0001]。中医药联合常规疗法与常规治疗的血清钙水平比较,差异有统计学意义MD=0.16,95%CI(0.08,0.23),P<0.001]、血清磷水平MD=-0.17,95%CI(-0.23,-0.11),P<0.00001]、甲状旁腺素激素水平MD=-38.71,95%CI(-54.88,-22.55),P<0.00001],通过Meta回归找到异质性来源,并排除相应研究,再经敏感性分析发现血清钙、血清磷、甲状旁腺激素水平的结果都很稳定。结论:中医药联合常规疗法可以有效改善患者临床症状,提高有效率,改善血清钙、血清磷、甲状旁腺激素水平。但由于所纳入研究样本量少、质量不高,仍需开展更多高质量、大量本、多中心的研究予以验证。

Meta Analysis of TCM Combined with Conventional Therapy in the Treatment of Renal Osteodystrophy

Objective:To systematically evaluate the clinical efficacy and safety of traditional Chinese medicine combined with conventional therapy in the treatment of renal osteodystrophy.Methods:The databases of CNKI,Wanfang Journal,PubM ed and Cochrane Central,etc.were searched by computer.The randomized controlled trial(RCT)of TCM in the treatment of renal osteodystrophy was searched.The Meta analysis was carried out by Revman 5.3 software.Results:A total of 24 RCTs were included,including 1552 patients with renal osteodystrophy.The results of Meta analysis showed that there was a statistical difference between the efficacy of TCM combined with conventional therapy and that of conventional therapyRR=1.30,95%CI(1.18,1.44),P<001].Sub group analysis showed that the clinical efficacy of method of tonifying kidney and activating blood circulation was the bestRR=1.47,95%CI(1.30,1.67),P<0.0001].There was significant difference in serum calcium level between TCM combined with conventional therapy and conventional therapyMD=0.16,95%CI(0.08,0.23),P<0.001].In terms of serum phosphorus levelMD=-0.17,95%CI(-0.23,-0.11),P<0.00001],parathyroid hormone levelMD=-38.71,95%CI(-54.88,-22.55),P<0.00001],the heterogeneity source was found by Meta regression,and the corresponding research was excluded.Sensitivity analysis showed that the results of serum calcium,serum phosphorus and parathyroid hormone were all stable.Conclusion:TCM combined with conventional therapy can effectively improve the clinical symptoms,the efficiency,the levels of serum calcium,serum phosphorus and parathyroid hormone.However,due to the small number and low quality of the research samples,more high-quality,large-scale,multi center studies are still needed to verify.