• 四川大學(xué)華西醫(yī)院腎內(nèi)科,成都,610041;

目的 　評價(jià)川芎嗪治療原發(fā)性腎病綜合征的有效性、臨床安全性,為臨床實(shí)踐提供循證醫(yī)學(xué)證據(jù).
方法 　計(jì)算機(jī)檢索MEDLINE(1966.1～2002.12)、EMBASE(1975～2002.12)、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(1979.1～2002.12)、中國循證醫(yī)學(xué)/Cochrane中心數(shù)據(jù)庫、Cochrane圖書館、SCI (1985～2002.12)等數(shù)據(jù)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(fā)性腎病綜合征的隨機(jī)對照試驗(yàn).根據(jù)Jadad質(zhì)量記分法進(jìn)行質(zhì)量評定,選擇近期療效、遠(yuǎn)期療效和治療期及隨訪期發(fā)生副作用的病例數(shù)等作為評價(jià)指標(biāo),提取數(shù)據(jù)并采用Cochrane協(xié)作網(wǎng)專用軟件RevMan4.1進(jìn)行統(tǒng)計(jì)分析.
結(jié)果 　檢索到符合納入標(biāo)準(zhǔn)的隨機(jī)對照試驗(yàn) 13篇,共675例病人.均為Jadad質(zhì)量計(jì)分均為1分的低質(zhì)量研究.4個研究的Meta分析結(jié)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(yīng)尚不清楚.納入研究的資料中,缺乏川芎嗪降低原發(fā)性腎病綜合征復(fù)發(fā)率的研究.
結(jié)論 　目前較低質(zhì)量研究的Meta分析提示,在激素/免疫抑制劑基礎(chǔ)上使用川芎嗪有提高原發(fā)性腎病綜合征近期療效的作用,尤其是對高凝狀態(tài)和一過性腎功能不全患者.無川芎嗪降低原發(fā)性腎病綜合征復(fù)發(fā)率的有力證據(jù).尚未發(fā)現(xiàn)川芎嗪的嚴(yán)重副作用.但并不能認(rèn)為川芎嗪治療原發(fā)性腎病綜合征安全.其遠(yuǎn)期療效和安全性還有待于設(shè)計(jì)嚴(yán)格的多中心、大樣本隨機(jī)對照試驗(yàn)進(jìn)一步證實(shí).

引用本文： 簡訊,樊均明,李孜,羅海,蘇白海. 川芎嗪治療原發(fā)性腎病綜合征的系統(tǒng)評價(jià). 中國循證醫(yī)學(xué)雜志, 2004, 04(9): 627-633. doi: 復(fù)制

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