文献类型：期刊文献

中文题名：中西医结合治疗小儿原发性肾病综合征随机对照试验的Meta分析

英文题名：A Meta-analysis of Randomized Controlled Trials on Integrative Medicine Treatment for Primary Nephritic Syndrome in Children

作者：吕彩兰[1];戴恩来[2];吴建军[3];魏锦慧[4];徐厚谦[2]

第一作者：吕彩兰

机构：[1]甘肃中医学院附属医院儿科,兰州730000;[2]甘肃中医学院中医内科教研室,兰州730000;[3]甘肃中医学院医学统计学教研室,兰州730000;[4]甘肃中医学院附属医院肾病科,兰州730000

第一机构：甘肃中医药大学第二附属医院

年份：2013

卷号：42

期号：1

起止页码：87

中文期刊名：华中科技大学学报（医学版）

外文期刊名：Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

收录：CSTPCD;;北大核心:【北大核心2011】；CSCD:【CSCD2013_2014】；PubMed;

语种：中文

中文关键词：Meta分析;随机对照试验;原发性肾病综合征;小儿

外文关键词：Meta-analysis; randomized controlled trials; primary nephritic syndrome; children

摘要：目的评价中西医结合治疗小儿原发性肾病综合征的疗效。方法计算机检索2000～2010年PubMed、Medline、中国生物医学文献光盘数据库(CBM disc)、中文期刊网全文数据库(CNKI)、中国优秀博硕士学位论文全文数据库(CDMD)、万方数据库、Cochrane Library(2010,第2期);并手工检索纳入文献的参考文献、相关学位论文和会议论文集。由2名研究人员分别独立检索、筛选文献,并独立对纳入文献依据Jadad量表进行质量评价和数据提取。用Rev-Man 5.1.5软件进行Meta分析。结果①共纳入17篇文献,980例患者,其中治疗组535例,对照组445例。除1篇Jadad评分3分的文献外,其余均为1～2分的低质量文献。各研究均明确指出基线均衡,具有可比性。有2篇文献提到使用随机数字表,其余文献只提到随机分组,但并未详细描述随机序列的产生方法。所有纳入文献均未对随机分配方案进行隐藏,均未使用盲法;②Meta分析结果显示:中西医结合疗法治疗小儿原发性肾病综合征在减少24h尿蛋白定量(UPT)(SMD-0.74,95%CI[-1.12,-0.37])、升高血浆白蛋白(ALB)(SMD 0.64,95%CI[0.38,0.90])、降低血脂(TC:MD-1.24,95%CI[-1.80,-0.69];TG:MD-0.41,95%CI[-0.66,-0.17])、减少复发率(RR 0.39,95%CI[0.30,0.52])和缩短水肿消退时间(MD-4.30,95%CI[-5.19,-3.41])方面优于常规激素或激素加免疫抑制剂治疗,且差异有统计学意义。结论在激素或激素加免疫抑制剂常规治疗的基础上加用中医药治疗,对小儿原发性肾病综合征患者24hUPT、血脂(TC、TG)、复发率的降低,水肿消退时间的缩短及升高ALB方面的作用优于常规治疗,且敏感性分析未能从实质上改变Meta分析的结果,但纳入该Meta分析的文献方法学质量较低,而且可能存在发表性偏倚,因此,尚有待于设计严密规范的大样本、多中心、随机双盲对照研究进一步证实。
Objective To evaluate the efficacy of integrated medicine treatment for primary nephrotic syndrome in children. Methods Databases including PubMed （2000--2010）, Medline （2000 2010）, the Cochrane Library （2010.2）, CBM （2000--2010） ,CNKI （2000--2010） ,CDMD （2000--2010） and Wanfang Database （2000~2010） were searched to identify randomized controlled trials （RCTs） on integrated medicine treatment for primary nephrotic syndrome in children. The selection of studies, assessment of methodological quality and data extraction were performed independently by two researchers. The methodological quality was assessed by using the Jadad scale and Meta-analyses were performed by using the Cochrane Collaboration＇s RevMan 5.1.5 software. Results A total of 17 studies,involving 980 patients （535 in the treatment group,and 445 in the control group）, were identified. Only one study had a Jadad scale score of 3, and the rest had a score of 1 or 2. Baseline data of the studies were comparable. All the studies reported random methods but they did not mention blinding and allocation concealment. The use of random number table by random grouping was shown in two studies. The results of the Meta-analysis indicated that combination o{ traditional Chinese and western medicine therapy was superior to conventional glucocorticoid treat- ment in decreasing TC （MD：--1.24,95% CI [-1.80,--0.69]）,TG （MD：-0.41,95~CI：[--0.66,--0.17]）,relapse rate （RR：0.39,95MCI：[0.30,0.52]） ,and 24-h urine protein （SMD：--0.74,95MCI：[--1.12,--0.37]） ,shortening the time of e- dema subsiding （MD：-4.30,95%CI：[-5.19,--3.41]） and elevating serum ALB level （SMD..0.64,95%CI [0.38,0.90]）. Conclusion The Meta-analysis results suggested that the efficacy of the integrated medicine therapy for primary nephrotic syndrome in children is better. The result of sensitivity analysis was not significantly different from that of Metaanalysis. However,the studies used for the Meta-analysis had lower methodological quality,and the publication bias might exist. Randomized double-blind controlled studies with large samples are needed to further confirm the efficacy of integrated medi cine treatment for primary nephritic syndrome in children.