造影劑腎病中西醫(yī)結(jié)合預(yù)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(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(jìn)行評價;4.收集數(shù)據(jù);5.對研究結(jié)果進(jìn)行分析和報告;6.解釋結(jié)果;7.改進(jìn)和更新原有評價)嚴(yán)格制定詳細(xì)的納入標(biāo)準(zhǔn)與排除標(biāo)準(zhǔn)等。計算機檢索相關(guān)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(xué)文獻(xiàn)數(shù)據(jù)庫、中國科學(xué)引文數(shù)據(jù)庫等收集自2008-2017年中西醫(yī)結(jié)合(治療組)相比其他方式(對照組)預(yù)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(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),并分別評價文獻(xiàn)質(zhì)量,提取資料后再進(jìn)行相互核對,采用Rev Man 5.3統(tǒng)計軟件進(jìn)行Meta分析。評價指標(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RCT,合計2738例,中西醫(yī)結(jié)合治療組1375例,對照組1363例,與對照組相比較,(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(xué)異質(zhì)性(P0.00001,I2=78%),采用隨機效應(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照組。(3)15項研究對對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)于對照組,發(fā)生不良反應(yīng)情況較對照組明顯減少。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(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692
本文編號：2228823
[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)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 鄭壁偉;李玉靖;夏裕;;固本排毒方預(yù)防造影劑腎病療效觀察[J];山西中醫(yī);2017年03期
2 姚筱;李寧;谷欣;韓志明;龍宏杰;;川芎嗪對經(jīng)皮冠脈介入術(shù)后造影劑腎病的預(yù)防作用研究[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2016年35期
3 陳曉杰;劉祖發(fā);劉杰;李寧;楊大為;于潔;;益氣活血化痰方預(yù)防冠脈造影后造影劑腎病的臨床研究[J];北京中醫(yī)藥;2016年11期
4 袁亮;陸冰;李殿富;王連生;楊志健;;銀杏達(dá)莫注射液對老年腎功能不全患者造影劑腎病的影響[J];江蘇醫(yī)藥;2016年21期
5 陳海威;張津津;熊丹;李良;翟紅霞;劉潤梅;夏云峰;;腎康注射液對老年慢性腎病患者造影劑腎病的防治作用[J];中國中西醫(yī)結(jié)合雜志;2016年07期
6 王銘;李勇;楊特;;五苓散對急性冠脈綜合征患者經(jīng)皮冠狀動脈介入術(shù)后發(fā)生對比劑腎病的影響[J];中國中醫(yī)急癥;2016年06期
7 唐小斌;陳忠;張騰飛;何楠;劉丹;王曉娜;寇鐳;吳章敏;劉暉;王盛;吳慶華;;低滲與等滲造影劑對外周血管介入患者發(fā)生造影劑腎病的比較研究[J];心肺血管病雜志;2016年05期
8 楊增芯;鄭若龍;;丹紅注射液聯(lián)合水化預(yù)防急診PCI術(shù)后CIN的效果探討[J];承德醫(yī)學(xué)院學(xué)報;2015年05期
9 曹紅霞;梁改琴;賈有福;張倩;;金水寶膠囊預(yù)防冠脈造影后對比劑腎病的臨床研究[J];中國初級衛(wèi)生保健;2015年10期
10 郭雪紅;;黃芪注射液的藥理作用及臨床應(yīng)用研究進(jìn)展[J];中國藥房;2015年21期
相關(guān)碩士學(xué)位論文 前4條
1 黃程;不同類型對比劑對75歲以上老年人行冠脈介入術(shù)后腎功能的影響[D];福建醫(yī)科大學(xué);2014年
2 張貴春;丹參川芎嗪對血瘀型冠心病患者PCI術(shù)后腎臟保護作用的臨床研究[D];福建中醫(yī)藥大學(xué);2013年
3 張全成;加味溫膽湯預(yù)防冠心病患者冠狀動脈介入診療術(shù)后對比劑腎病的臨床研究[D];山東中醫(yī)藥大學(xué);2013年
4 梁海龍;益氣活血化痰法對冠心病患者介入診療術(shù)后造影劑腎損害影響的研究[D];廣州中醫(yī)藥大學(xué);2008年
，本文編號：2228823
本文鏈接：http://www.lk138.cn/yixuelunwen/mjlw/2228823.html
最近更新
教材專著
