中药内服方联合肾脏替代疗法治疗脓毒症急性肾损伤临床疗效和安全性的系统评价及Meta分析  

Systematic Review and Meta-analysis of Clinical Efficacy and Safety of Traditional Chinese Medicine Oral Formula Combined with Renal Replacement Therapy in the Treatment of Sepsis Introduced Acute Kidney Injury

作　　者：赵舒曼 何龙[1] 耿彦婷[1] 石嘉恒 杨叶蓓蕾 闫子民 刘益诚 齐文升[1] Zhao Shuman;He Long;Geng Yanting;Shi Jiaheng;Yang Yebeilei;Yan Zimin;Liu Yicheng;Qi Wensheng(Guang′anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《中国中医急症》2024年第5期769-774,共6页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(81973683);中国中医科学院科技创新工程(CI2021A02901)。

摘　　要：目的对中药内服方联合肾脏替代疗法(RRT)治疗脓毒症急性肾损伤的临床疗效以及安全性进行系统性评价及Meta分析。方法检索建库至2023年6月17日,中国知网、万方数据库、中文科技期刊数据库、中国生物医学文献数据库、Web of Science、PubMed、Embase、Cochrane Library中收录的文献,纳入符合标准的中药内服方联合RRT治疗脓毒症急性肾损伤患者的随机对照试验(RCT)。文献质量评价采用Cochrane风险偏倚评估工具进行,并运用RevMan 5.4.1软件进行最终数据分析。结果9篇RCT共包括681例脓毒症急性肾损伤患者最终被纳入。与单纯运用RRT相比较,中药内服方联合RRT清除TNF-α作用更强[MD=-29.48,95%CI(-44.81,-14.15),P=0.0002]、IL-6水平[MD=-28.83,95%CI(-38.84,-18.82),P<0.0001]、Scr水平[MD=-21.86,95%CI(-44.10,0.38),P=0.05]、NGAL水平[MD=-12.25,95%CI(-16.90,-7.60),P<0.0001]、Cys C水平[MD=-0.45,95%CI(-0.49,-0.42),P<0.0001]、APACHEⅡ评分[MD=-3.20,95%CI(-3.89,-2.50),P<0.0001]、SOFA评分[MD=-1.78,95%CI(-2.19,-1.37),P<0.0001]及病死率[RR=0.42,95%CI(0.26,0.68),P=0.0004]均更低。仅1篇文献报道了不良反应,未有文献报道安全性指标。结论中药内服方联合RRT可以缓解脓毒症急性肾损伤患者炎症反应,保护肾功能,减低患者死亡率,但上述结论仍需多中心、大样本的RCT研究进一步验证。Objective:To conduct meta-analysis of evaluation of the clinical efficacy and safety of Traditional Chinese Medicine(TCM)oral formula combined with renal replacement therapy(RRT)in the treatment of sepsis introduced acute kidney injury.Methods:From the database′s inception to June 17th,2023,the literature in the CNKI,Wanfang database,Chinese Sci-tech Journal Database,Chinese Biomedical Literature Database,Web of Sci⁃ence,PubMed,Embase,and Cochrane Library was searched for RCT of TCM oral formulas combined with RRT for the treatment of patients with septic acute kidney injury.The Cochrane risk bias assessment method was used to assess the quality of the literature.For data analysis,RevMan 5.4.1 software was employed.Results:A total of 681 patients with septic acute kidney injury were included in 9 RCTs.Compared with RRT alone,TCM oral formu⁃la combined with RRT could clear TNF-α[MD=-29.48,95%CI(-44.81,-14.15),P=0.0002],IL-6 level[MD=-28.83,95%CI(-38.84,-18.82),P<0.0001],Scr level[MD=-21.86,95%CI(-44.10,0.38),P=0.05],NGAL lev⁃el[MD=-12.25,95%CI(-16.90,-7.60),P<0.0001],Cys C level[MD=-0.45,95%CI(-0.49,-0.42),P<0.0001],APACHEⅡscore[MD=-3.20,95%CI(-3.89,-2.50),P<0.0001],SOFA score[MD=-1.78,95%CI(-2.19,-1.37),P<0.0001],the mortality rate[RR=0.42,95%CI(0.26,0.68),P=0.0004]were all lower.Only one literature re⁃ported adverse reactions,and no literature reported safety indicators.Conclusion:TCM oral formula combined with RRT can alleviate the inflammatory reaction of patients with septic acute kidney injury,protect the renal function of patients,and reduce the mortality of patients,but the above conclusion still needs to be further verified by a multi center,large sample RCT study.

关 键 词：脓毒症 急性肾衰竭 肾脏替代疗法 META分析 

分 类 号：R631[医药卫生—外科学]