肾病综合征水肿治疗效果的循证医学证据  

Evidence-based therapy of nephrotic edema

作　　者：刘喜红[1] 易著文[1] 陈丹[1] 曾雪琪[1] 黄丹琳[1] 姜奕[1] 

机构地区：[1]中南大学湘雅二医院小儿肾脏病研究室,湖南长沙410011

出　　处：《中国当代儿科杂志》2007年第2期139-143,共5页Chinese Journal of Contemporary Pediatrics

摘　　要：目的通过对有关肾病综合征水肿治疗的临床研究进行系统评价，从而总结肾病水肿的治疗证据，以此指导临床应用。方法以“肾病综合征”、“水肿或顽固性水肿或难治性水肿”、“治疗或利尿治疗”为中文关键词，以“nephrotig edema或recalcitrnnt edema或refractory edema或resistant nephrotic edema”、“treatment或diuretic therapy或human albumin”为英文关键词，采用电子和手工检索中国生物医学文献数据库（CBM disc）、中国期刊全文数据库（CNKI，1994—2006．12）、维普中文科技期刊数据库（1989-）、中国循证医学／Cochrane中心数据库（CEBM／CCD）、Cochrane图书馆等数据库、MEDLINE（1966．11-2006．2）、EMBASE（1975-2006．12）、MEDLARS、SCI（1985-2006．12）及OVID。搜集有关肾病综合征水肿的治疗临床研究，并对其中符合纳入标准的随机对照试验（ROT）采用Cochrane协作网专用软件RevMan4．2进行统计分析。结果初检出有关文献113篇，其中中文60篇，英文53篇。病例回顾性分析所占比例较大，仅12篇为RCT。国内10篇RCT均为低质量研究，国外2篇RCT病例数少，且观察指标不统一，只能对其中3篇进行Meta分析，发现低分子右旋糖酐联合速尿对肾病水肿的治疗有效；白蛋白建议用于伴随有严重低白蛋白血症的肾病水肿；联合应用利尿剂或速尿持续静脉点滴可以用于对速尿抵抗的肾病水肿。结论肾病水肿的治疗应个体化，其证据目前并不能明确定论，尚有待于设计严格的、多中心、大样本的随机对照实验。Objective To study the evidence-based therapy of edema in nephrotic syndrome by analyzing the literatures systematically. Methods The literatures related to the treatment of nephrotic edema were retrieved from the following： Chinese Biological Medicine Database （CBM-disk） , Chinese Journals Full-text Database （CNKI, 1994-2006）, Chinese Technological Periodicals Database （VIP, 1989-2006）, Chinese Evidence Biological Medicine/Cochrane Central Database （CEBM/CCD）, Cochrane Library Database, MEDLINE （1966-2006）, EMBASE （1975-2006）, MEDLARS, SCI （1985-2006） and OVID by electron and craft search with the following key words： nephrotic syndrome, edema, recalcitrant edema, refractory edema or resistant nephrotic edema, and treatment, diuretic therapy or human albumin treatment. The relevant literatures on randomized controlled trials （RCT） that met the criteria were statistically analyzed by the Coorporative network software RevMan 4.2. Results A total of 113 articles were searched （60 in Chinese and 53 in English）, of which 12 were RCT. Three of the 12 articles were included for Meta analysis. Meta analysis showed that dextran-40 together with furosemide was effective for nephrotic edema. Human albumin solution could be used in nephrotic edema patients with coexistent severe hypoalbuminemia. A combination of diuretics by intravenous drip infusion was effective for diuretic-resistant nephrotic edema. Conclusions The treatment for nephrotic edema should be individualized. The evidence of treatment of nephrotic edema has not been fully elucidated. Further multicentre, large sample, and randomized controlled trials are needed.

关 键 词：肾病综合征 水肿 随机对照实验 循征治疗 

分 类 号：R692.3[医药卫生—泌尿科学]