李孜 1 , 卿平 2 , 冀玲 1 , 蘇白海 1 , 何俐 3 , 樊均明 1
  • 1. 四川大學(xué)華西醫(yī)院腎臟內(nèi)科,成都,6100412. 四川大學(xué)華西臨床醫(yī)學(xué)院教務(wù)處3. 四川大學(xué)華西醫(yī)院神經(jīng)內(nèi)科;

目的 　評價(jià)大黃治療慢性腎功能衰竭、延緩慢性腎功衰進(jìn)展的療效及安全性.
方法 　計(jì)算機(jī)檢索Medline數(shù)據(jù)庫、Cochrane 圖書館臨床對照試驗(yàn)資料庫、中國生物醫(yī)學(xué)文獻(xiàn)光盤數(shù)據(jù)庫,檢索年限從建庫～2000年12月.人工檢索 lt;中華腎臟病雜志 gt;等15種腎臟病和中醫(yī)中藥的核心雜志,檢索年限從1980年1月至2000年12月.查找符合納入標(biāo)準(zhǔn)的隨機(jī)/半隨機(jī)對照試驗(yàn),進(jìn)行質(zhì)量評價(jià),而后提取相關(guān)數(shù)據(jù)進(jìn)行Meta分析,統(tǒng)計(jì)軟件用RevMan 4.1.
結(jié)果 　共納入18篇隨機(jī)/半隨機(jī)對照試驗(yàn),有1 322例病人符合納入標(biāo)準(zhǔn),但其方法學(xué)質(zhì)量均較低.與非中藥治療處理相比,大黃治療慢性腎功能衰竭在降低血肌酐、尿素氮、減輕癥狀、糾正貧血與營養(yǎng)不良方面有一定療效.在減少死亡人數(shù) [OR 0.15,95%CI (0.06,0.36), P =0.000]、減少終末期腎病發(fā)生 [OR 0.38, 95%CI (0.09,1.64), P =0.19 ] 方面,由于樣本例數(shù)太少,療效仍不肯定.
結(jié)論 　大黃治療慢性腎功能衰竭可能有效,但延緩慢性腎功衰進(jìn)展的作用尚不肯定.還需要設(shè)計(jì)良好的大規(guī)模、多中心隨機(jī)對照試驗(yàn)做進(jìn)一步證實(shí).

引用本文： 李孜,卿平,冀玲,蘇白海,何俐,樊均明. 大黃治療慢性腎功能衰竭的系統(tǒng)評價(jià). 中國循證醫(yī)學(xué)雜志, 2004, 04(7): 468-473. doi: 復(fù)制

1. 桑棟.中西醫(yī)結(jié)合治療慢性腎功能不全患者的療效觀察 [J].中國中西醫(yī)結(jié)合急救雜志,1999; 6(8):367～369.
2. ［20］Zhu PJ,Zhou X,Wei XJ.Effect of Baoyuan Qiangsheng Ⅱtablet to plasma and urine SOD,MDA in chronic renal failre patients [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1997; 17(11):649-652.
3. 朱辟疆,周遜,韋先進(jìn).保元強(qiáng)腎Ⅱ號(hào)對慢性腎功能衰竭血漿及尿SOD、MDA的影響 [J].中國中西醫(yī)結(jié)合雜志,1997; 17(11):649～652.
4. ［21］Zhang JH,Li LS,Zhang M.Clinical effects of rheum and captopril on preventing progression of chronic renal failure [J].Chinese Medical Journal,1990; 103(10):788-793.
5. ［22］Zheng PD.The discussion of the mechanism of rhubarb to treat azotemia [J].Shanghai Traditional Chinese Medicine,1985;(8):46.
6. 鄭平東.大黃治療氮質(zhì)血癥及其作用機(jī)制的探討 [J].上海中醫(yī)藥雜志,1985; (8):46.
7. ［23］Liu JP,Liu C,Leng TJ.Evaluation of clinical trials for viral hepatitis in the past nine years in Chinese medical literatures [J].West China Medical Journal,1999; 14(3):264-265.
8. 劉建平,劉暢,冷泰俊.病毒性肝炎臨床治療試驗(yàn)9年文獻(xiàn)評價(jià)[J].華西醫(yī)學(xué),1999; (3):264～265.
9. ［1］Yang JW,Li LS.The experiment study of Rhubarb delaying chronic renal failure [J].Journal of Chinese Nephrology,1993; 9(2):65-68.
10. 楊俊偉,黎磊石.大黃延緩慢性腎衰發(fā)展的實(shí)驗(yàn)研究 [J].中華腎臟病雜志,1993; 9(2):65～68.
11. ［2］Pedrini MT,Levey AS,Lau J,Chalmers TC,Wang PH.The effect of dietary protein restriction on the progressive of diabetic and nondiabetic renal disease [J].Ann Intern Med,1996; 124(7):627-632.
12. ［3］Giatral I,Lau J,Levey AS.Effect of angiotensin-converting enzyme inhibitor on the progression of nondiabetic renal disease:a meta-analysis of randomized trials.Angiotensin-Converting-Enzyme Inhibitor Progressive Renal Disease Study Group [J].Ann Intern Med,1997;127(5):337-345.
13. ［4］Wu XX.Clinical research of compound Rhubarb by rectal administration to delay the progression of chronic renal failure [J].New Traditional Chinese Medicine,1994; 26(6):24-25吳錫信.復(fù)方大黃灌腸液延緩慢性腎功能衰竭進(jìn)展的臨床研究 [J].新中醫(yī),1994; 26(6):24～25.
14. ［5］Sum WS,Qiao CL,Yang SX,Liu R,Zhou QF.The effect comparison between aid chi eliminate waste and aid chi invigorating kidney on chronic renal failure [J].Practical clinical emergency journal of Integrated Traditional Chinese with Western Medicine,1996; 3(10):433-435.
15. 孫萬森,喬成林,楊世興,劉銳,周清發(fā).益氣泄?jié)岱ê鸵鏆庋a(bǔ)腎法治療慢性腎功能衰竭療效比較 [J].中西醫(yī)結(jié)合實(shí)用臨床急救,1996; 3(10):433～435.
16. ［6］Song HX,Wang ZF,Zhang FF,Zhou H.The detection of urine IL-6 and the effect of rhubarb on chronic renal failure patient [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,2000; 20(2):107-109.
17. 宋海翔,王子芬,張鳳芳,周慧.慢性腎功能衰竭患者尿白細(xì)胞介素6的檢測及大黃對其影響 [J].中國中西醫(yī)結(jié)合雜志,2000; 20(2):107～109.
18. ［7］Li YL,Yang N,Lin KX.The protection function of traditional medicine,Man Shen Kang,to the resident renal function on hemodialytic patients [J].Chinese emergence Journal of Integrated Traditional Chinese and Western Medicine,1999; 6(12):564-565.
19. 李燕林,楊楠,林凱旋.中藥"慢腎康"對血液透析患者殘余腎功能的保護(hù)作用觀察 [J].中國中西醫(yī)結(jié)合急救雜志,1999; 6(12):564～565.
20. ［8］Wang KL,Tan SF.The effect observation of combined Traditional Chinese and Western Medicine on uremia [J].Practical clinical emergency journal of Integrated Traditional Chinese with Western Medicine,1998; 5(4):175-176.
21. 汪開蓮,譚士芬.中西醫(yī)結(jié)合救治尿毒癥療效觀察 [J].中西醫(yī)結(jié)合實(shí)用臨床急救,1998; 5(4):175～176.
22. ［9］Wu ZM,Shi JL,Liu WM.Treatment of 60 chronic renal failure cases with Shen Shuai Ning capsule[J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1998;18(9):558-559.
23. 吳仲明,師晶麗,劉為民.腎衰寧膠囊治療慢性腎功能不全60例 [J].中國中西醫(yī)結(jié)合雜志,1998;18(9):558～559.
24. ［10］Qou QA.The clinical observation of treatment of 48 chronic renal failure cases with Qian Cao Chongji [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine.2000; 20(2):141-142.
25. 寇秋愛.仙草沖劑治療48例慢性腎功能衰竭的臨床觀察 [J].中國中西醫(yī)結(jié)合雜志,2000; 20(2):141～142.
26. ［11］Zhang SG,Xiong GL,Yang X.Primary clinical and experimental study of treatment of chronic renal insufficient with aid chi invigorating kidney Chongji [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1992; 12(6):335-337.
27. ［12］Chen YP,Liu WZ,Shen LM,Shen JF,Xu SN.The effect observation of traditional Chinese medicine to chronic renal failure [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine.1986; 6(8):465-467.
28. 陳以平,劉慰祖,沈玲妹,沈靜芬,徐嵩年.中醫(yī)中藥治療慢性腎功能衰竭療效觀察[J].中西醫(yī)結(jié)合雜志,1986; 6(8):465～467.
29. ［13］Ji SM,Li LS,Ji DX.The clinical research of Baoshen Pill on maitainance hemodialysis patients [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1993; 13(2):71-73.
30. 季曙明,黎磊石,季大璽.保腎丸治療長期血液透析患者的臨床研究 [J].中國中西醫(yī)結(jié)合雜志,1993; 13(2):71～73.
31. ［14］Yu YS,Li LS,Zhang X.The long-term effect observation of rhubarb to chronic renal failure [J].Journal of Nephrology Dialysis Transplantation,1995; 4(1):32-35.
32. 俞雨生,黎磊石,章旭.中藥大黃治療慢性腎衰的遠(yuǎn)期療效觀察 [J].腎臟病與透析腎移植雜志,1995; 4(1):32～35.
33. ［15］Zhang JH,Li LS,Wang BZ.The effect of rhubarb to lipid metabolism in chronic renal patients [J].Journal of Chinese Nephrology,1993; 9(3):133-135.
34. 張景紅,黎磊石,萬柏珍.大黃對慢性腎衰病人脂質(zhì)代謝的影響 [J].中華腎臟病雜志,1993; 9(3):133～135.
35. ［16］Zhang JH,Yao XD,Song Y.The long-term effect of retarding chronic renal failure progression with rhubarb and catopril [J].Journal of Chinese Nephrology.1993; 9(4):197-201.
36. 張景紅,姚小丹,宋巖.大黃與巰甲丙脯酸延緩慢性腎衰進(jìn)展的遠(yuǎn)期療效 [J].中華腎臟病雜志,1993; 9(4):197～201.
37. ［17］Li YY,Ren XF,Song Y.Treatment of 189 chronic renal failure cases with hemodialysis and retarding kidney soup [J].Journal of Traditional Chinese Medicine,1994; 35(8):483-484.
38. 李毓英,任秀芬,楊桂英.血液透析配合延腎湯治療慢性腎功能衰竭189例 [J].中醫(yī)雜志,1994; 35(8):483～484.
39. ［18］Yu YM,Cui JQ,Zhang F.Chinese drugs for invigorating spleen to remove dampness,activating blood circulation to eliminate turbid in retarding progression of chronic renal failure [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,2000; 20(10):727-728.
40. 余月明,崔建強(qiáng),張凡.健脾利濕、活血化濁中藥延緩慢性腎功能衰竭 [J].中國中西醫(yī)結(jié)合雜志,2000; 20(10):727～728.
41. ［19］Sang D.The effect observation of Integrated Traditional Chinese and Western Medicine to treat chronic renal failure [J].Chinese emergence Journal of Integrated Traditional Chinese and Western Medicine,1999; 6(8):367-369.
  1. 1. 桑棟.中西醫(yī)結(jié)合治療慢性腎功能不全患者的療效觀察 [J].中國中西醫(yī)結(jié)合急救雜志,1999; 6(8):367～369.
  2. 2. ［20］Zhu PJ,Zhou X,Wei XJ.Effect of Baoyuan Qiangsheng Ⅱtablet to plasma and urine SOD,MDA in chronic renal failre patients [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1997; 17(11):649-652.
  3. 3. 朱辟疆,周遜,韋先進(jìn).保元強(qiáng)腎Ⅱ號(hào)對慢性腎功能衰竭血漿及尿SOD、MDA的影響 [J].中國中西醫(yī)結(jié)合雜志,1997; 17(11):649～652.
  4. 4. ［21］Zhang JH,Li LS,Zhang M.Clinical effects of rheum and captopril on preventing progression of chronic renal failure [J].Chinese Medical Journal,1990; 103(10):788-793.
  5. 5. ［22］Zheng PD.The discussion of the mechanism of rhubarb to treat azotemia [J].Shanghai Traditional Chinese Medicine,1985;(8):46.
  6. 6. 鄭平東.大黃治療氮質(zhì)血癥及其作用機(jī)制的探討 [J].上海中醫(yī)藥雜志,1985; (8):46.
  7. 7. ［23］Liu JP,Liu C,Leng TJ.Evaluation of clinical trials for viral hepatitis in the past nine years in Chinese medical literatures [J].West China Medical Journal,1999; 14(3):264-265.
  8. 8. 劉建平,劉暢,冷泰俊.病毒性肝炎臨床治療試驗(yàn)9年文獻(xiàn)評價(jià)[J].華西醫(yī)學(xué),1999; (3):264～265.
  9. 9. ［1］Yang JW,Li LS.The experiment study of Rhubarb delaying chronic renal failure [J].Journal of Chinese Nephrology,1993; 9(2):65-68.
  10. 10. 楊俊偉,黎磊石.大黃延緩慢性腎衰發(fā)展的實(shí)驗(yàn)研究 [J].中華腎臟病雜志,1993; 9(2):65～68.
  11. 11. ［2］Pedrini MT,Levey AS,Lau J,Chalmers TC,Wang PH.The effect of dietary protein restriction on the progressive of diabetic and nondiabetic renal disease [J].Ann Intern Med,1996; 124(7):627-632.
  12. 12. ［3］Giatral I,Lau J,Levey AS.Effect of angiotensin-converting enzyme inhibitor on the progression of nondiabetic renal disease:a meta-analysis of randomized trials.Angiotensin-Converting-Enzyme Inhibitor Progressive Renal Disease Study Group [J].Ann Intern Med,1997;127(5):337-345.
  13. 13. ［4］Wu XX.Clinical research of compound Rhubarb by rectal administration to delay the progression of chronic renal failure [J].New Traditional Chinese Medicine,1994; 26(6):24-25吳錫信.復(fù)方大黃灌腸液延緩慢性腎功能衰竭進(jìn)展的臨床研究 [J].新中醫(yī),1994; 26(6):24～25.
  14. 14. ［5］Sum WS,Qiao CL,Yang SX,Liu R,Zhou QF.The effect comparison between aid chi eliminate waste and aid chi invigorating kidney on chronic renal failure [J].Practical clinical emergency journal of Integrated Traditional Chinese with Western Medicine,1996; 3(10):433-435.
  15. 15. 孫萬森,喬成林,楊世興,劉銳,周清發(fā).益氣泄?jié)岱ê鸵鏆庋a(bǔ)腎法治療慢性腎功能衰竭療效比較 [J].中西醫(yī)結(jié)合實(shí)用臨床急救,1996; 3(10):433～435.
  16. 16. ［6］Song HX,Wang ZF,Zhang FF,Zhou H.The detection of urine IL-6 and the effect of rhubarb on chronic renal failure patient [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,2000; 20(2):107-109.
  17. 17. 宋海翔,王子芬,張鳳芳,周慧.慢性腎功能衰竭患者尿白細(xì)胞介素6的檢測及大黃對其影響 [J].中國中西醫(yī)結(jié)合雜志,2000; 20(2):107～109.
  18. 18. ［7］Li YL,Yang N,Lin KX.The protection function of traditional medicine,Man Shen Kang,to the resident renal function on hemodialytic patients [J].Chinese emergence Journal of Integrated Traditional Chinese and Western Medicine,1999; 6(12):564-565.
  19. 19. 李燕林,楊楠,林凱旋.中藥"慢腎康"對血液透析患者殘余腎功能的保護(hù)作用觀察 [J].中國中西醫(yī)結(jié)合急救雜志,1999; 6(12):564～565.
  20. 20. ［8］Wang KL,Tan SF.The effect observation of combined Traditional Chinese and Western Medicine on uremia [J].Practical clinical emergency journal of Integrated Traditional Chinese with Western Medicine,1998; 5(4):175-176.
  21. 21. 汪開蓮,譚士芬.中西醫(yī)結(jié)合救治尿毒癥療效觀察 [J].中西醫(yī)結(jié)合實(shí)用臨床急救,1998; 5(4):175～176.
  22. 22. ［9］Wu ZM,Shi JL,Liu WM.Treatment of 60 chronic renal failure cases with Shen Shuai Ning capsule[J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1998;18(9):558-559.
  23. 23. 吳仲明,師晶麗,劉為民.腎衰寧膠囊治療慢性腎功能不全60例 [J].中國中西醫(yī)結(jié)合雜志,1998;18(9):558～559.
  24. 24. ［10］Qou QA.The clinical observation of treatment of 48 chronic renal failure cases with Qian Cao Chongji [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine.2000; 20(2):141-142.
  25. 25. 寇秋愛.仙草沖劑治療48例慢性腎功能衰竭的臨床觀察 [J].中國中西醫(yī)結(jié)合雜志,2000; 20(2):141～142.
  26. 26. ［11］Zhang SG,Xiong GL,Yang X.Primary clinical and experimental study of treatment of chronic renal insufficient with aid chi invigorating kidney Chongji [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1992; 12(6):335-337.
  27. 27. ［12］Chen YP,Liu WZ,Shen LM,Shen JF,Xu SN.The effect observation of traditional Chinese medicine to chronic renal failure [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine.1986; 6(8):465-467.
  28. 28. 陳以平,劉慰祖,沈玲妹,沈靜芬,徐嵩年.中醫(yī)中藥治療慢性腎功能衰竭療效觀察[J].中西醫(yī)結(jié)合雜志,1986; 6(8):465～467.
  29. 29. ［13］Ji SM,Li LS,Ji DX.The clinical research of Baoshen Pill on maitainance hemodialysis patients [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1993; 13(2):71-73.
  30. 30. 季曙明,黎磊石,季大璽.保腎丸治療長期血液透析患者的臨床研究 [J].中國中西醫(yī)結(jié)合雜志,1993; 13(2):71～73.
  31. 31. ［14］Yu YS,Li LS,Zhang X.The long-term effect observation of rhubarb to chronic renal failure [J].Journal of Nephrology Dialysis Transplantation,1995; 4(1):32-35.
  32. 32. 俞雨生,黎磊石,章旭.中藥大黃治療慢性腎衰的遠(yuǎn)期療效觀察 [J].腎臟病與透析腎移植雜志,1995; 4(1):32～35.
  33. 33. ［15］Zhang JH,Li LS,Wang BZ.The effect of rhubarb to lipid metabolism in chronic renal patients [J].Journal of Chinese Nephrology,1993; 9(3):133-135.
  34. 34. 張景紅,黎磊石,萬柏珍.大黃對慢性腎衰病人脂質(zhì)代謝的影響 [J].中華腎臟病雜志,1993; 9(3):133～135.
  35. 35. ［16］Zhang JH,Yao XD,Song Y.The long-term effect of retarding chronic renal failure progression with rhubarb and catopril [J].Journal of Chinese Nephrology.1993; 9(4):197-201.
  36. 36. 張景紅,姚小丹,宋巖.大黃與巰甲丙脯酸延緩慢性腎衰進(jìn)展的遠(yuǎn)期療效 [J].中華腎臟病雜志,1993; 9(4):197～201.
  37. 37. ［17］Li YY,Ren XF,Song Y.Treatment of 189 chronic renal failure cases with hemodialysis and retarding kidney soup [J].Journal of Traditional Chinese Medicine,1994; 35(8):483-484.
  38. 38. 李毓英,任秀芬,楊桂英.血液透析配合延腎湯治療慢性腎功能衰竭189例 [J].中醫(yī)雜志,1994; 35(8):483～484.
  39. 39. ［18］Yu YM,Cui JQ,Zhang F.Chinese drugs for invigorating spleen to remove dampness,activating blood circulation to eliminate turbid in retarding progression of chronic renal failure [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,2000; 20(10):727-728.
  40. 40. 余月明,崔建強(qiáng),張凡.健脾利濕、活血化濁中藥延緩慢性腎功能衰竭 [J].中國中西醫(yī)結(jié)合雜志,2000; 20(10):727～728.
  41. 41. ［19］Sang D.The effect observation of Integrated Traditional Chinese and Western Medicine to treat chronic renal failure [J].Chinese emergence Journal of Integrated Traditional Chinese and Western Medicine,1999; 6(8):367-369.