川芎嗪治療原發性腎病綜合征的系統評價_《中國循證醫學雜志》

作者：

簡訊 , 樊均明 , 李孜 , 羅海 , 蘇白海

四川大學華西醫院腎內科,成都,610041;

關鍵詞：

川芎嗪腎病綜合征系統評價 Meta分析

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目的　評價川芎嗪治療原發性腎病綜合征的有效性、臨床安全性,為臨床實踐提供循證醫學證據.
方法　計算機檢索MEDLINE(1966.1～2002.12)、EMBASE(1975～2002.12)、中國生物醫學文獻數據庫(1979.1～2002.12)、中國循證醫學/Cochrane中心數據庫、Cochrane圖書館、SCI (1985～2002.12)等數據庫和手工檢索 lt;中華腎臟病雜志 gt;等15種雜志(1980～2003.2),收集川芎嗪與激素/免疫抑制劑治療原發性腎病綜合征的隨機對照試驗.根據Jadad質量記分法進行質量評定,選擇近期療效、遠期療效和治療期及隨訪期發生副作用的病例數等作為評價指標,提取數據并采用Cochrane協作網專用軟件RevMan4.1進行統計分析.
結果　檢索到符合納入標準的隨機對照試驗 13篇,共675例病人.均為Jadad質量計分均為1分的低質量研究.4個研究的Meta分析結果顯示,川芎嗪可提高近期治療腎病綜合征綜合的療效[OR 4.24, 95%CI (1.76,10.19)] ,改善24 h尿蛋白定量[OR -0.36, 95%CI (-0.71,-0.02)] 、血肌酐水平[兒童組OR -3.34, 95%CI (-5.25,-1.43); 成人組OR -48.29, 95%CI (-68.24,-28.35)]血漿白蛋白水平[OR 3.61, 95%CI(2.61,4.61)]等.但川芎嗪的長期副反應尚不清楚.納入研究的資料中,缺乏川芎嗪降低原發性腎病綜合征復發率的研究.
結論　目前較低質量研究的Meta分析提示,在激素/免疫抑制劑基礎上使用川芎嗪有提高原發性腎病綜合征近期療效的作用,尤其是對高凝狀態和一過性腎功能不全患者.無川芎嗪降低原發性腎病綜合征復發率的有力證據.尚未發現川芎嗪的嚴重副作用.但并不能認為川芎嗪治療原發性腎病綜合征安全.其遠期療效和安全性還有待于設計嚴格的多中心、大樣本隨機對照試驗進一步證實.

引用本文： 簡訊,樊均明,李孜,羅海,蘇白海. 川芎嗪治療原發性腎病綜合征的系統評價. 中國循證醫學雜志, 2004, 04(9): 627-633. doi: 復制

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3. 金淑雪. 川芎嗪配合中藥治療腎病綜合征高凝血癥臨床觀察[J]. 中國中醫急癥, 2001; 10(5): 270.
4. ［16］Qiu L,Fan PJ,Han CH. The effect of Ligustrazine with Mongolian for 22 nephrotic syndrome patients[J]. Journal of Medicine, 2002; 21(6): 365-367.
5. 邱麗,范培金,韓翠華.川芎嗪和黃芪注射液佐治腎病綜合征22例[J]. 醫藥導報, 2002; 21(6): 365～367.
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《中國循證醫學雜志》

川芎嗪治療原發性腎病綜合征的系統評價

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《中國循證醫學雜志》

川芎嗪治療原發性腎病綜合征的系統評價

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