本文選題：慢性腎功能不全 + 中醫(yī)藥��； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過系統(tǒng)回顧中醫(yī)藥治療慢性腎功能不全的隨機(jī)對照試驗(yàn)相關(guān)文獻(xiàn),評價(jià)中醫(yī)藥對中晚期患者疾病進(jìn)展的有效性及安全性,在此基礎(chǔ)上通過臨床回顧性觀察,進(jìn)一步探索中醫(yī)藥對患者進(jìn)入透析結(jié)局的影響,篩選影響透析結(jié)局發(fā)生的相關(guān)因素。方法:檢索2006年1月1日至2015年12月31日10年間相關(guān)期刊論文(CNKI)、中國科技期刊數(shù)據(jù)庫(VIP)、中國生物醫(yī)學(xué)期刊數(shù)據(jù)庫(CBM)、萬方學(xué)位論文數(shù)據(jù)庫四個(gè)中文數(shù)據(jù)庫以及PubMed、EMBASE、Cochrane Library英文數(shù)據(jù)庫中中醫(yī)治療慢性腎功能不全的隨機(jī)對照試驗(yàn),系統(tǒng)評價(jià)中藥治療的有效性及安全性,使用Review Manager 5.3軟件進(jìn)行Meta分析。采用回顧性-隊(duì)列研究,篩選中日友好醫(yī)院2012年1月1日至2015年12月31日出院主診斷為慢性腎臟病中晚期(CKD4-5期)未進(jìn)入透析的病人,記錄患者基本特征、臨床檢驗(yàn)指標(biāo)、用藥信息并且隨訪患者預(yù)后情況,對透析結(jié)局發(fā)生情況進(jìn)行統(tǒng)計(jì)分析。最后運(yùn)用COX回歸模型分析篩選影響透析結(jié)局發(fā)生的危險(xiǎn)因素。結(jié)果:(1)文獻(xiàn)研究共檢索到相關(guān)文獻(xiàn)721篇,最終納入11篇文獻(xiàn)進(jìn)行meta分析,結(jié)果顯示中藥可能對慢性腎功能不全患者癥狀、體征以及腎小球?yàn)V過率的改善,血肌酐、血尿素氮、24小時(shí)尿蛋白定量的降低具有一定的作用;對于安全性指標(biāo)及不良反應(yīng)的報(bào)告相對較少,尚不能評價(jià)中藥治療的安全性;缺乏針對疾病進(jìn)展的終點(diǎn)結(jié)局事件發(fā)生的研究,亟待進(jìn)一步的臨床研究評估中藥治療慢性腎臟病的遠(yuǎn)期療效;(2)臨床研究根據(jù)納排標(biāo)準(zhǔn)共篩選出CKD4-5期患者120例,以中藥干預(yù)治療做為暴露因素分為干預(yù)組(中西醫(yī)治療)47例,非干預(yù)組(西醫(yī)治療)73例進(jìn)行為期1年的訪視觀察,進(jìn)入透析結(jié)局患者49例,其中干預(yù)組12例進(jìn)入透析,透析率為25.53%,非干預(yù)組進(jìn)入透析人數(shù)為37人,透析率為50.68%,相對危險(xiǎn)度RR=0.501,提示中藥治療是影響進(jìn)入透析的保護(hù)因素。進(jìn)入透析與未進(jìn)入透析患者相比,兩組的中藥使用情況、糖尿病并發(fā)癥、年齡、C02結(jié)合力以及高磷、低鈣、貧血情況均具有顯著差異(P0.05),將以上具有統(tǒng)計(jì)學(xué)意義的變量逐步引入COX多因素回歸模型中,結(jié)果顯示中藥干預(yù)是透析結(jié)局發(fā)生的保護(hù)因素,貧血、糖尿病并發(fā)癥與高磷、低鈣體征是影響透析結(jié)局的獨(dú)立危險(xiǎn)因素。結(jié)論:(1)中醫(yī)藥可以提高慢性腎功能不全的治療療效,延緩?fù)肝鼋Y(jié)局的發(fā)生,但仍需今后大樣本、多中心、前瞻性隨機(jī)對照試驗(yàn)來進(jìn)一步證實(shí)中醫(yī)藥可以延緩慢性腎臟病的進(jìn)展。(2)中藥干預(yù)措施是影響進(jìn)入透析結(jié)局的保護(hù)性因素,高磷、低鈣、高血糖、貧血癥狀體征是影響透析結(jié)局的獨(dú)立危險(xiǎn)因素,因此積極使用中醫(yī)中藥進(jìn)行干預(yù),同時(shí)監(jiān)控改善患者血紅蛋白、血糖、鈣磷指標(biāo)是預(yù)防CKD進(jìn)展的有效措施。
[Abstract]:Objective: to evaluate the efficacy and safety of traditional Chinese medicine (TCM) in the treatment of chronic renal insufficiency (CRD) by reviewing the literature of randomized controlled trials on the treatment of chronic renal insufficiency (CRD), and to evaluate the efficacy and safety of TCM in the progression of middle and late stage diseases.To further explore the impact of Chinese medicine on the outcome of dialysis patients into dialysis, screening the relevant factors affecting the outcome of dialysis.Methods: four Chinese databases, CNKI, VIPI, CBMN, CBMN, and Wanfang thesis database, were searched from January 1, 2006 to December 31, 2015, and from January 1, 2006 to December 31, 2015.And a randomized controlled trial on the treatment of chronic renal dysfunction with traditional Chinese medicine (TCM) in the PubMedus EMBASE Cochrane Library English database,The efficacy and safety of traditional Chinese medicine were systematically evaluated and Meta analysis was performed with Review Manager 5.3 software.A retrospective cohort study was used to screen the patients who were not undergoing dialysis in China-Japan Friendship Hospital from January 1, 2012 to December 31, 2015.Medication information and prognosis of the patients were followed up and the outcome of dialysis was statistically analyzed.Finally, COX regression model was used to analyze and screen the risk factors affecting dialysis outcome.Results (1) A total of 721 related papers were retrieved and 11 papers were included in the study for meta analysis. The results showed that Chinese herbal medicine might improve the symptoms, signs and glomerular filtration rate of patients with chronic renal insufficiency, and serum creatinine.The quantitative reduction of urinary protein in 24 hours of blood urea nitrogen has a certain effect, and the safety index and adverse reactions are relatively few, so it is not possible to evaluate the safety of traditional Chinese medicine treatment.There is a lack of research on the outcome events of disease progression. It is urgent for further clinical research to evaluate the long-term efficacy of traditional Chinese medicine in the treatment of chronic kidney disease.According to the Chinese medicine intervention therapy as the exposure factor, the intervention group was divided into two groups: the intervention group (47 cases) and the non-intervention group (73 cases) for a period of one year, 49 patients entered the dialysis outcome, among which 12 cases in the intervention group entered dialysis.The dialysis rate was 25.53, the number of people in the non-intervention group was 37, the dialysis rate was 50.68, and the relative risk was RRR0.501, suggesting that the treatment of Chinese medicine was the protective factor affecting the entry into dialysis.Compared with the patients without dialysis, the two groups were treated with traditional Chinese medicine, diabetes complications, age C02 binding capacity, high phosphorus, low calcium,There were significant differences in anemia (P 0.05). The above statistical variables were gradually introduced into COX multivariate regression model. The results showed that Chinese medicine intervention was the protective factor of dialysis outcome, anemia, diabetic complications and high phosphorus.Hypocalcemia is an independent risk factor for dialysis outcomes.Conclusion 1) traditional Chinese medicine can improve the therapeutic effect of chronic renal insufficiency and delay the occurrence of dialysis outcome, but it still needs a large sample and multi-center in the future.Prospective randomized controlled trials to further confirm that Chinese medicine can delay the progression of chronic kidney disease.) Chinese medicine intervention is a protective factor that affects the outcome of dialysis, high phosphorus, low calcium, high blood sugar,The symptoms and signs of anemia are independent risk factors affecting the outcome of hemodialysis, so it is an effective measure to prevent the progress of CKD by actively using Chinese medicine to intervene and to monitor and improve the hemoglobin, blood glucose and calcium and phosphorus index of patients.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R277.5

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