Preventive Effect of Different Chinese Patent TCM Injections for Activating Blood Circulation and Removing Blood Stasis with Usual Hydration on Contrast-induced Nephropathy：a Network Meta-analysis

doi:10.12114/j.issn.1007-9572.2020.00.574

Abstract

Abstract: Background　Many clinical trials have confirmed that a variety of Chinese patent TCM injections for activating blood circulation and removing blood stasis with usual hydration may prevent contrast-induced nephropathy（CIN）to some extent，but there is a lack of systematic review.Objective　To evaluate the effect of different Chinese patent TCM injections for activating blood circulation and removing blood stasis with usual hydration on preventing CIN，providing evidence-based evidence for clinical rational use of such medicines.Methods　Databases including Cochrane Library，EMBase，PubMed，CNKI，SinoMed，CQVI and Wanfang Data were searched for RCTs about different Chinese patent TCM injections for activating blood circulation and removing blood stasis with hydration（test group）versus usual hydration（control group）in preventing CIN from inception to November 2019.Stata 15.0 was used to conduct network meta-analysis.Results　A total of 19 RCTs were included，involving 2 433 patients.The analysis revealed that，the therapies were ranked as follows in terms of effect of decreasing the incidence of CIN：Ligustrazine injection with usual hydration>Xuebijing injection with usual hydration>Ginseng and aconite injection with usual hydration>Danhong injection with usual hydration>Erigeron breviscapus injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Shenkang injection with usual hydration>Sofren injection with usual hydration>Miltiorrhizae polyphenolate injection with usual hydration>Yinxingdamo injection with usual hydration> usual hydration.For decreasing the Ccr after CAG/PCI，the ranking results were：Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Erigeron breviscapus injection with usual hydration>Yinxingdamo injection with usual hydration>Sofren injection with usual hydration>Xuebijing injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Ginseng and aconite injection with usual hydration>Danhong injection with usual hydration>usual hydration.For decreasing the Scr after CAG/PCI，the ranking results were：Erigeron breviscapus injection with usual hydration>Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Ligustrazine injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Sofren injection with usual hydration>Yinxingdamo injection with usual hydration>Shenkang injection with usual hydration>Ginseng and aconite injection with usual hydration>Xuebijing injection with usual hydration>Danhong injection with usual hydration>usual hydration.For decreasing the BUN after CAG/PCI，the ranking results were：Ginseng and aconite injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Sofren injection with usual hydration>Danhong injection with usual hydration>usual hydration.Conclusion　The available literature evidence indicates that，Ligustrazine injection with usual hydration may be an optimal therapy for decreasing the incidence of CIN；Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration may be an optimal therapy for decreasing Ccr after CAG/PCI；Erigeron breviscapus injection with usual hydration may be the best therapy in decreasing Scr after CAG/PCI，and Ginseng and aconite injection with usual hydration may be the best therapy in decreasing BUN after CAG/PCI.

Key words: Nephrosis, Contrast media, Extravasation of diagnostic and therapeutic materials, Chinese patent drugs, Injectio, Blood urea nitrogen, Network meta-analysis

摘要： 背景　目前已有大量临床试验证实多种活血化瘀类中成药注射液联合常规水化对造影剂肾病（CIN）有一定预防作用，但尚缺乏系统评价。目的　评价不同活血化瘀类中成药注射液联合常规水化对CIN的预防效果，旨在为临床合理选用活血化瘀类中成药注射液预防CIN提供循证医学证据。方法　计算机检索Cochrane Library、EMBase、PubMed、中国知网、中国生物医学文献数据库（CBM）、维普网、万方数据知识服务平台，检索时间限定为建库至 2019年11月，筛选关于不同活血化瘀类中成药注射液联合常规水化（试验组）与常规水化（对照组）对CIN预防效果的随机对照试验。采用Stata 15.0软件进行网状Meta分析。结果　最终纳入19项随机对照试验（RCTs），共包括2 433例患者。在降低CIN发生率方面，网状Meta分析排序结果为川芎嗪注射液联合常规水化>血必净注射液联合常规水化>参附注射液联合常规水化>丹红注射液联合常规水化>灯盏细辛注射液联合常规水化>丹参川芎嗪注射液联合常规水化>参芎葡萄糖注射液联合常规水化>肾康注射液联合常规水化>大株红景天注射液联合常规水化>丹参多酚酸盐注射液联合常规水化>银杏达莫注射液联合常规水化>常规水化；在降低冠状动脉造影（CAG）/经皮冠状动脉介入治疗（PCI）后内生肌酐清除率方面，网状Meta分析排序结果为参芎葡萄糖注射液联合常规水化>灯盏细辛注射液联合常规水化>银杏达莫注射液联合常规水化>大株红景天注射液联合常规水化>血必净注射液联合常规水化>丹参川芎嗪注射液联合常规水化>参附注射液联合常规水化>丹红注射液联合常规水化>常规水化；在降低CAG/PCI后血肌酐方面，网状Meta分析排序结果为灯盏细辛注射液联合常规水化>参芎葡萄糖注射液联合常规水化>川芎嗪注射液联合常规水化>丹参川芎嗪注射液联合常规水化>大株红景天注射液联合常规水化>银杏达莫注射液联合常规水化>肾康注射液联合常规水化>参附注射液联合常规水化>血必净注射液联合常规水化>丹红注射液联合常规水化>常规水化；在降低CAG/PCI后血尿素氮方面，网状Meta分析排序结果为参附注射液联合常规水化>丹参川芎嗪注射液联合常规水化>大株红景天注射液常规联合水化>丹红注射液联合常规水化>常规水化。结论　现有文献证据表明，在降低CIN发生率方面，川芎嗪注射液联合常规水化治疗效果最佳；在降低CAG/PCI后内生肌酐清除率方面，参芎葡萄糖注射液联合常规水化治疗效果最佳；在降低CAG/PCI后血肌酐方面，灯盏细辛注射液联合常规水化治疗效果最佳；在降低CAG/PCI后血尿素氮方面，参附注射液联合常规水化治疗效果最佳。

关键词: 肾病, 造影剂, 诊断和治疗物质外渗, 中成药, 注射剂, 血尿素氮, 网状Meta分析

HUANG Yingjie,LIU Jiayue,ZHAN Qunzhang, et al. Preventive Effect of Different Chinese Patent TCM Injections for Activating Blood Circulation and Removing Blood Stasis with Usual Hydration on Contrast-induced Nephropathy：a Network Meta-analysis　[J]. Chinese General Practice, 2021, 24(18): 2318-2330. DOI: 10.12114/j.issn.1007-9572.2020.00.574.
黄英杰,刘家玥,詹群璋等. 不同活血化瘀类中成药注射液联合常规水化对造影剂肾病预防效果的网状Meta分析[J]. 中国全科医学, 2021, 24(18): 2318-2330. DOI: 10.12114/j.issn.1007-9572.2020.00.574.

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