發(fā)布時(shí)間：2018-09-07 16:41

【摘要】：目的:系統(tǒng)評(píng)價(jià)中西醫(yī)結(jié)合預(yù)防造影劑腎病的臨床有效性及安全性,以期為臨床預(yù)防造影劑腎病提供相關(guān)循證依據(jù)。材料與方法:按照Cochrane系統(tǒng)評(píng)價(jià)的步驟(即1.提出問題;2.確定和選擇原始研究報(bào)告;3.對(duì)原始研究報(bào)告進(jìn)行評(píng)價(jià);4.收集數(shù)據(jù);5.對(duì)研究結(jié)果進(jìn)行分析和報(bào)告;6.解釋結(jié)果;7.改進(jìn)和更新原有評(píng)價(jià))嚴(yán)格制定詳細(xì)的納入標(biāo)準(zhǔn)與排除標(biāo)準(zhǔn)等。計(jì)算機(jī)檢索相關(guān)期刊論文、中文科技期刊全文數(shù)據(jù)庫(kù)、萬方數(shù)據(jù)庫(kù)、重慶維普數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)、中國(guó)科學(xué)引文數(shù)據(jù)庫(kù)等收集自2008-2017年中西醫(yī)結(jié)合(治療組)相比其他方式(對(duì)照組)預(yù)防造影劑腎病(CIN)的隨機(jī)對(duì)照試驗(yàn)(RCT),兩名研究者獨(dú)立評(píng)估檢索的文章中使用的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),并分別評(píng)價(jià)文獻(xiàn)質(zhì)量,提取資料后再進(jìn)行相互核對(duì),采用Rev Man 5.3統(tǒng)計(jì)軟件進(jìn)行Meta分析。評(píng)價(jià)指標(biāo):CIN發(fā)病率、血清肌酐值(Scr)、不良反應(yīng)發(fā)生情況。結(jié)果:共納入23項(xiàng)RCT,合計(jì)2738例,中西醫(yī)結(jié)合治療組1375例,對(duì)照組1363例,與對(duì)照組相比較,(1)23篇文獻(xiàn)比較了中西醫(yī)結(jié)合用藥與對(duì)照組用藥預(yù)防造影劑腎病的發(fā)生率:各研究間無統(tǒng)計(jì)學(xué)異質(zhì)性(P=1.00,I2=0%),應(yīng)用固定效應(yīng)模型進(jìn)行分析。Meta分析結(jié)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(jì)學(xué)意義,提示中西醫(yī)結(jié)合預(yù)防造影劑腎病的發(fā)病率明顯優(yōu)于對(duì)照組,可降低CIN發(fā)病率。(2)23項(xiàng)研究報(bào)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(jì)學(xué)異質(zhì)性(P0.00001,I2=78%),采用隨機(jī)效應(yīng)模型分析。Meta分析結(jié)果顯示,[MD=-11.24,95%CI(-12.76,-9.72),P0.00001],差異有統(tǒng)計(jì)學(xué)意義。提示患者經(jīng)過中西醫(yī)結(jié)合藥物治療后,治療組平均血清肌酐值要明顯低于對(duì)照組。(3)15項(xiàng)研究對(duì)對(duì)照組和治療組用藥后的不良反應(yīng)發(fā)生情況進(jìn)行了說明,各研究間無統(tǒng)計(jì)學(xué)異質(zhì)性(P=1.00,I2=0%),采用固定效應(yīng)模型分析。Meta分析結(jié)果顯示,[OR=0.22,95%CI(0.10,0.49),P=0.0002],差異統(tǒng)計(jì)學(xué)意義,提示中西醫(yī)結(jié)合藥物預(yù)防造影劑腎病,臨床中不良反應(yīng)發(fā)生情況較西醫(yī)組少。結(jié)論:中西醫(yī)結(jié)合預(yù)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(duì)照組,發(fā)生不良反應(yīng)情況較對(duì)照組明顯減少。本研究納入文獻(xiàn)有限,臨床中,尚需更多質(zhì)量更高的隨機(jī)對(duì)照試驗(yàn)予以證實(shí)。
[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(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692

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本文編號(hào)：2228823