藥用炭治療慢性腎臟疾病的系統評價_《中國循證醫學雜志》

作者：

1. 西藏自治區人民醫院內三科（拉薩 850000）；2. 四川大學華西醫院老年病科（成都 610041）；3. 四川大學華西醫院西藏成辦分院（成都 610041）;

關鍵詞：

藥用炭慢性腎臟疾病隨機對照試驗系統評價 Meta 分析

DOI：

10.7507/1672-2531.20090239

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目的　系統評價藥用炭治療慢性腎臟疾病的療效和安全性。
方法　按照國際Cochrane 協作網的系統評價方法，檢索Cochrane 圖書館臨床對照試驗數據庫（2009 年第1 期）、MEDLINE（1950 ～ 2009 年1 月）、EMbase（1980 ～ 2009 年1 月），中國生物醫學文獻數據庫（1977 ～ 2009 年1 月）和中國期刊全文數據庫（1994 ～ 2009 年1 月），納入所有藥用炭治療慢性腎臟疾病的隨機對照試驗。根據Cochrane 系統評價員手冊4.2.2 版評估納入試驗的偏倚風險，應用RevMan 5.0 軟件進行統計分析。
結果　共納入7 個研究，包括347 例患者。Meta 分析結果顯示：① 經藥用炭治療后，患者血清尿素氮［SMD= –0.69，95%CI（–1.13，–0.24），P=0.002］、血清肌酐［SMD= –0.51，95%CI（–0.94，–0.08），P=0.02］和腎小球濾過率月變化量（P lt;0.001）改善優于常規治療；但24 h 尿蛋白定量和平均血壓的改善未見優于常規治療；② 與安慰劑比較，治療后終末期腎病發生率、血清肌酐、24 h 尿蛋白定量和內生肌酐清除率的改善不優于安慰劑(P gt;0.05）；③ 不良反應主要有便秘、惡心和腹脹，且大多癥狀輕微。
結論　由于納入試驗較少，目前的證據尚不能對藥用炭治療慢性腎臟疾病的有效性及安全性做出肯定的評價，還需開展更多大樣本、高質量的隨機對照試驗進一步證實。

引用本文： 孫紅娟,吳紅梅,王鋒,李婷. 藥用炭治療慢性腎臟疾病的系統評價. 中國循證醫學雜志, 2009, 09(12): 1310-1314. doi: 10.7507/1672-2531.20090239 復制

1.	Brenner BM. Nephrology forum:hemodynamically mediated glomerular injury and the progressive nature of renal disease. Kidney Int, 1983, 23: 647-655.
2.	Fouque D, Laville M, Boissel JP. Low protein diets for chronic kidney disease in non-diabetic adults. Cochrane Database Systeamtic Review, 2006, 19: CD001892.
3.	龔偉, 李世軍, 王金泉. 血管緊張素轉換酶抑制劑與血管緊張素Ⅱ受體拮抗劑; 何者對心腎的保護作用更強. 腎臟病與透析腎移植雜志, 2005, 14: 197-199.
4.	National Kidney Foundation. DOQI kidney disease outcome quality initiative. Am J Kidney Dis, 2002, 39(Suppl 1): S1-S266.
5.	Juni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
6.	Owada A, Nakao M, Koike J. Effects of oral adsorbent AST-120 on the progression of chronic renal failure:A randomized controlled study. Kidney International, 1997, 52(Suppl 63): S188-S190.
7.	李彬, 張澎, 馬秀琴. 醫學活性炭保留灌腸治療慢性腎功能衰竭短期療效觀察. 寧夏醫學雜志, 2004, 12(26): 804.
8.	Sanaka T, Sugino N, Teraoka S, et al. Therapeutic Effects of Oral Sorbent in Undialyzed Uremia. Am J of Kidney Dis, 1988, 12(8): 97-103.
9.	Nakamura T, Kawagoe Y, Matsuda T. Oral Adsorbent AST-120 Decrsases Carotid Intima-Media Thickness and Thickness and Arterial Stiffness in Patients with Chronic Renal Failure. Kidney Blood Press Res, 2004, 27: 121-126.
10.	Shoji T, Wada A, Inoue K. Prospective randomized study evaluating the efficacy of the spherical adsorptive carbon ast-120 in chronic kidney disease patients with moderate decrease in renal function. Nephron Clin Pract, 2007, 105: c99-c107.
11.	Marier JF, James Lee, Rama S, et al. Effect of Repeated Oral Administrations of the Oral Adsorbent AST-120 on Serum Creatinine and Other Markers of Renal Function. Am J Nephrol, 2006, 26: 136-141.
12.	Schulman G, Agarwal R, Acharya M. A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging Study of AST-120 (Kremezin) in Patients With Moderate to Severe CKD. Am J of Kidney Dis, 2006, 47: 565-577.
13.	Taki K, Niwa T. Indoxyl sulfate-lowering capacity of oral sorbents affects the prognosis of kidney function and oxidative stress in chronic kidney disease. J Ren Nutr, 2007, 17(1): 48-52.
14.	Ueda H, Shibahara N, Takagi S, et al. AST-120 treatment in predialysis period affects the prognosis in patients on hemodialysis. Ren Fail, 2008, 30(9): 856-860.
15.	Yoshida Y, Tadasu S, Ise M. Effects of oral adsorbent in the rat model of chronic renal failure. Nephron, 1992, 62: 305-314.
16.	Takahashi T, Reed SD, Schulman KA. Cost-effectiveness of the oral adsorbent AST-120 versus placebo for chronic kidney disease. Nephrology (Carlton), 2008, 13(5): 419-427.

1. Brenner BM. Nephrology forum:hemodynamically mediated glomerular injury and the progressive nature of renal disease. Kidney Int, 1983, 23: 647-655.
2. Fouque D, Laville M, Boissel JP. Low protein diets for chronic kidney disease in non-diabetic adults. Cochrane Database Systeamtic Review, 2006, 19: CD001892.
3. 龔偉, 李世軍, 王金泉. 血管緊張素轉換酶抑制劑與血管緊張素Ⅱ受體拮抗劑; 何者對心腎的保護作用更強. 腎臟病與透析腎移植雜志, 2005, 14: 197-199.
4. National Kidney Foundation. DOQI kidney disease outcome quality initiative. Am J Kidney Dis, 2002, 39(Suppl 1): S1-S266.
5. Juni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
6. Owada A, Nakao M, Koike J. Effects of oral adsorbent AST-120 on the progression of chronic renal failure:A randomized controlled study. Kidney International, 1997, 52(Suppl 63): S188-S190.
7. 李彬, 張澎, 馬秀琴. 醫學活性炭保留灌腸治療慢性腎功能衰竭短期療效觀察. 寧夏醫學雜志, 2004, 12(26): 804.
8. Sanaka T, Sugino N, Teraoka S, et al. Therapeutic Effects of Oral Sorbent in Undialyzed Uremia. Am J of Kidney Dis, 1988, 12(8): 97-103.
9. Nakamura T, Kawagoe Y, Matsuda T. Oral Adsorbent AST-120 Decrsases Carotid Intima-Media Thickness and Thickness and Arterial Stiffness in Patients with Chronic Renal Failure. Kidney Blood Press Res, 2004, 27: 121-126.
10. Shoji T, Wada A, Inoue K. Prospective randomized study evaluating the efficacy of the spherical adsorptive carbon ast-120 in chronic kidney disease patients with moderate decrease in renal function. Nephron Clin Pract, 2007, 105: c99-c107.
11. Marier JF, James Lee, Rama S, et al. Effect of Repeated Oral Administrations of the Oral Adsorbent AST-120 on Serum Creatinine and Other Markers of Renal Function. Am J Nephrol, 2006, 26: 136-141.
12. Schulman G, Agarwal R, Acharya M. A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging Study of AST-120 (Kremezin) in Patients With Moderate to Severe CKD. Am J of Kidney Dis, 2006, 47: 565-577.
13. Taki K, Niwa T. Indoxyl sulfate-lowering capacity of oral sorbents affects the prognosis of kidney function and oxidative stress in chronic kidney disease. J Ren Nutr, 2007, 17(1): 48-52.
14. Ueda H, Shibahara N, Takagi S, et al. AST-120 treatment in predialysis period affects the prognosis in patients on hemodialysis. Ren Fail, 2008, 30(9): 856-860.
15. Yoshida Y, Tadasu S, Ise M. Effects of oral adsorbent in the rat model of chronic renal failure. Nephron, 1992, 62: 305-314.
16. Takahashi T, Reed SD, Schulman KA. Cost-effectiveness of the oral adsorbent AST-120 versus placebo for chronic kidney disease. Nephrology (Carlton), 2008, 13(5): 419-427.

《中國循證醫學雜志》

藥用炭治療慢性腎臟疾病的系統評價

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《中國循證醫學雜志》

藥用炭治療慢性腎臟疾病的系統評價

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