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造影劑腎病中西醫(yī)結合預防的meta分析

發(fā)布時間:2018-09-07 16:41
【摘要】:目的:系統(tǒng)評價中西醫(yī)結合預防造影劑腎病的臨床有效性及安全性,以期為臨床預防造影劑腎病提供相關循證依據(jù)。材料與方法:按照Cochrane系統(tǒng)評價的步驟(即1.提出問題;2.確定和選擇原始研究報告;3.對原始研究報告進行評價;4.收集數(shù)據(jù);5.對研究結果進行分析和報告;6.解釋結果;7.改進和更新原有評價)嚴格制定詳細的納入標準與排除標準等。計算機檢索相關期刊論文、中文科技期刊全文數(shù)據(jù)庫、萬方數(shù)據(jù)庫、重慶維普數(shù)據(jù)庫、中國生物醫(yī)學文獻數(shù)據(jù)庫、中國科學引文數(shù)據(jù)庫等收集自2008-2017年中西醫(yī)結合(治療組)相比其他方式(對照組)預防造影劑腎病(CIN)的隨機對照試驗(RCT),兩名研究者獨立評估檢索的文章中使用的納入標準和排除標準,并分別評價文獻質量,提取資料后再進行相互核對,采用Rev Man 5.3統(tǒng)計軟件進行Meta分析。評價指標:CIN發(fā)病率、血清肌酐值(Scr)、不良反應發(fā)生情況。結果:共納入23項RCT,合計2738例,中西醫(yī)結合治療組1375例,對照組1363例,與對照組相比較,(1)23篇文獻比較了中西醫(yī)結合用藥與對照組用藥預防造影劑腎病的發(fā)生率:各研究間無統(tǒng)計學異質性(P=1.00,I2=0%),應用固定效應模型進行分析。Meta分析結果顯示,[RR=0.25,95%CI(0.19,0.34),P0.00001],兩組臨床療效有效率差別具有統(tǒng)計學意義,提示中西醫(yī)結合預防造影劑腎病的發(fā)病率明顯優(yōu)于對照組,可降低CIN發(fā)病率。(2)23項研究報道了使用造影后1-7天的平均血清肌酐值,選取平均血清肌酐的最高值做meta分析研究,各研究間有統(tǒng)計學異質性(P0.00001,I2=78%),采用隨機效應模型分析。Meta分析結果顯示,[MD=-11.24,95%CI(-12.76,-9.72),P0.00001],差異有統(tǒng)計學意義。提示患者經(jīng)過中西醫(yī)結合藥物治療后,治療組平均血清肌酐值要明顯低于對照組。(3)15項研究對對照組和治療組用藥后的不良反應發(fā)生情況進行了說明,各研究間無統(tǒng)計學異質性(P=1.00,I2=0%),采用固定效應模型分析。Meta分析結果顯示,[OR=0.22,95%CI(0.10,0.49),P=0.0002],差異統(tǒng)計學意義,提示中西醫(yī)結合藥物預防造影劑腎病,臨床中不良反應發(fā)生情況較西醫(yī)組少。結論:中西醫(yī)結合預防造影劑腎病的發(fā)生、降低造影后血清肌酐值均明顯優(yōu)于對照組,發(fā)生不良反應情況較對照組明顯減少。本研究納入文獻有限,臨床中,尚需更多質量更高的隨機對照試驗予以證實。
[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.
【學位授予單位】:遼寧中醫(yī)藥大學
【學位級別】:碩士
【學位授予年份】:2017
【分類號】:R692

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