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.

References

［1］NASH K，HAFEEZ A，HOU S.Hospital-acquired renal insufficiency［J］．Am J Kidney Dis，2002，39（5）：930-936．DOI：10.1053/ajkd.2002.32766.
［2］中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南（2011年）［J］．中华骨质疏松和骨矿盐疾病杂志，2011，4（1）：2-17．DOI：10.3969/j.issn.1674-2591.2011.01.002.
［3］SEKIGUCHI H，AJIRO Y，UCHIDA Y，et al．Oxygen pre-conditioning prevents contrast-induced nephropathy（OPtion CIN Study）［J］．J Am Coll Cardiol，2013，62（2）：162-163．DOI：10.1016/j.jacc.2013.04.012.
［4］万立野，李宝群，毕红东.等渗及低渗造影剂对糖尿病合并轻中度肾功能不全患者肾毒性的对比研究［J］．实用医学杂志，2016，32（22）：3799-3800．DOI：10.3969/j.issn.1006-5725.2016.22.049.
［5］周小雁，汤雁蓉，张俊.肾康注射液与水化预防造影剂肾病疗效比较［J］．医药前沿，2019，9（5）：120-121.
［6］潘旭阳，李文华，江杰.丹参川芎嗪注射液对冠心病患者PCI术后对比剂肾病的预防效果［J］．中国医学前沿杂志（电子版），2018，10（12）：41-44．DOI：10.12037/YXQY.2018.12-10.
PAN X Y，LI W H，JIANG J.Prevention effect of Salviae miltiorrhizae and ligustrazine hydrochloride injection on contrast-induced nephropathy after percutaneous coronary intervention of coronary artery heart disease patients［J］．Chinese Journal of the Frontiers of Medical Science（Electronic Version），2018，10（12）：41-44．DOI：10.12037/YXQY.2018.12-10.
［7］周领，刘丽，张永乐.血必净防治对比剂肾功能损害临床对照研究［J］．山西中医，2017，33（2）：22-23，33．DOI：10.3969/j.issn.1000-7156.2017.02.008.
ZHOU L，LIU L，ZHANG Y L.Clinical controlled study on Xuebijing for prevention of renal damage due to contrast medium［J］．Shanxi Journal of Traditional Chinese Medicine，2017，33（2）：22-23，33．DOI：10.3969/j.issn.1000-7156.2017.02.008.
［8］薛世荣，黄景文，罗韶金，等．大株红景天注射液在PCI导致的对比剂肾病中的预防作用研究［J］．赣南医学院学报，2017，37（3）：383-385，405．DOI：10.3969/j.issn.1001-5779.2017.03.015.
XUE S R，HUANG S W，LUO Y J，et al．Prevention role of Sofren injection on contrast-induced nephropathy from PCI［J］．Journal of Gannan Medical University，2017，37（3）：383-385，405．DOI：10.3969/j.issn.1001-5779.2017.03.015.
［9］谢桂楠，高晟，赵凯，等．造影剂肾病的中医辨证探析［J］．中国中医急症，2018，27（12）：2159-2161．DOI：10.3969/j.issn.1004-745X.2018.12.026.
XIE J N，GAO C，ZHAO K，et al．Dialectical analysis of radiographic contrast nephropathy［J］．Journal of Emergency in Traditional Chinese Medicine，2018，27（12）：2159-2161．DOI：10.3969/j.issn.1004-745X.2018.12.026.
［10］杨丰文，张俊华，张伯礼.中医药网状Meta分析质量评价［J］．中华中医药杂志，2018，33（10）：4599-4606.
YANG F W，ZHANG J H，ZHANG B L.Quality of network Meta-analyses in field of traditional Chinese medicine［J］．China Journal of Traditional Chinese Medicine and Pharmacy，2018，33（10）：4599-4606.
［11］THOMSEN H S.Guidelines for contrast media from the European Society of Urogenital Radiology［J］．AJR Am J Roentgenol，2003，181（6）：1463-1471．DOI：10.2214/ajr.181.6.1811463.
［12］李在楠，王彩虹，杨斌.参芎葡萄糖联合水化治疗对造影剂肾病的防治作用［J］．中国继续医学教育，2017，9（3）：178-179．DOI：10.3969/j.issn.1674-9308.2017.03.100.
LI Z N，WANG C H，YANG B.The effect of Shenxiong glucose combined with hydration therapy on prevention of contrast induced nephropathy［J］．China Continuing Medical Education，2017，9（3）：178-179．DOI：10.3969/j.issn.1674-9308.2017.03.100.
［13］李晓.丹参川芎嗪注射液防治冠状动脉介入诊疗术后对比剂肾病的有效性研究［J］．山西中医学院学报，2017，18（4）：38-40，42.
LI X.Efficacy of Danshen Chuanxiongqin injection on contrast-induced nephropathy in patients undergoing elective percutaneous coronary intervention［J］．Journal of Shanxi College of Traditional Chinese Medicine，2017，18（4）：38-40，42.
［14］黄晶，袁敏杰，马士新，等．中药制剂丹参多酚酸盐对急诊经皮冠状动脉介入治疗术后对比剂肾病的保护作用［J］．中国介入心脏病学杂志，2017，25（1）：35-41．DOI：10.3969/j.issn.1004-8812.2017.01.009.
HUANG J，YUAN M J，MA S X，et al．Protective effects of salvianolate on contrast-induced nephropathy after primary percutaneous coronary intervention［J］．Chinese Journal of Interventional Cardiology，2017，25（1）：35-41．DOI：10.3969/j.issn.1004-8812.2017.01.009.
［15］GUO Z，NIU D，YU Y，et al．Effects of hydration combined with Shenfu injection on contrast-induced acute kidney injury in acute coronary syndrome patients undergoing percutaneous coronary intervention［J］．Biomed Rep，2017，7（5）：477-481．DOI：10.3892/br.2017.986.
［16］袁亮，陆冰，李殿富，等．银杏达莫注射液对老年肾功能不全患者造影剂肾病的影响［J］．江苏医药，2016，42（21）：2327-2329.
YUAN L，LU B，LI D F，et al．Effect of Ginkgo leaf extract and dipyridamole injection on contrast-induced nephropathy in senile patients with chronic renal insufficiency［J］．Jiangsu Medical Journal，2016，42（21）：2327-2329.
［17］姚筱，李宁，谷欣，等．川芎嗪对经皮冠脉介入术后造影剂肾病的预防作用研究［J］．现代中西医结合杂志，2016，25（35）：3942-3944．DOI：10.3969/j.issn.1008-8849.2016.35.023.
［18］薛峥.静脉水化联合参附注射液预防PCI术后对比剂肾病的临床观察［J］．中国中医急症，2016，25（11）：2187-2189．DOI：10.3969/j.issn.1004-745X.2016.11.059.
［19］杨增芯，郑若龙.丹红注射液联合水化预防急诊PCI术后CIN的效果探讨［J］．承德医学院学报，2015，32（5）：394-396.
［20］牛哲莉，李明明，杨洪娟，等．丹红注射液对造影剂肾病的预防作用［J］．河北中医，2015，37（5）：747-749．DOI：10.3969/j.issn.1002-2619.2015.05.039.
NIU Z L，LI M M，YANG H J，et al．Preventive effects of Danhong injection on contrast -induced nephropathy［J］．Hebei Journal of Traditional Chinese Medicine，2015，37（5）：747-749．DOI：10.3969/j.issn.1002-2619.2015.05.039.
［21］王新东，沈建平，娄彬.肾康注射液预防老年冠心病介入术后对比剂肾病的疗效观察［J］．南京中医药大学学报，2013，29（5）：426-428.
WANG X D，SHEN J P，LOU B.Observation on the effect of shenkang injection on preventing contrast-induced nephropathy after senile coronary heart disease interventional surgery［J］．Journal of Nanjing University of Traditional Chinese Medicine，2013，29（5）：426-428.
［22］刘骏涯，黎启华，殷建峰.丹红注射液预防冠心病患者介入诊疗术后对比剂肾病的疗效观察［J］．吉林医学，2013，34（31）：6474-6475.
LIU J Y，LI Q H，YIN J F.Clinical efficacy and prevention of Danhong injection in contrast-induced nephropathy（CIN）in patients with acute coronary syndrome undergoing percutaneous coronary intervention（PCI）［J］．Jilin Medical Journal，2013，34（31）：6474-6475.
［23］张爱军，刘涛生，黄磊，等．注射用丹参多酚酸盐对老年冠心病患者PCI术后对比剂肾病的预防作用［J］．中国老年学杂志，2012，32（24）：5523-5524．DOI：10.3969/j.issn.1005-9202.2012.24.073.
［24］王忠良，刘敏，张义勤.丹红注射液对PCI术后造影剂肾损害的预防作用［J］．中国中西医结合杂志，2011，31（12）：1611-1614.
WANG Z L，LIU M，ZHANG Y Q.The prevention of Danhong injection on contrast-induced renal impairment after percutaneous coronary intervention［J］．Chinese Journal of Integrated Traditional and Western Medicine，2011，31（12）：1611-1614.
［25］李文华，韩飞，李东野，等．丹红注射液防治急性冠脉综合征患者冠状动脉介入术后对比剂肾病的临床研究［J］．中国全科医学，2011，14（27）：3070-3072．DOI：10.3969/j.issn.1007-9572.2011.27.003.
LI W H，HAN F，LI D Y，et al．Prevention of contrast-induced nephropathy with Danhong injection in acute coronary syndrome patients undergoing percutaneous coronary intervention［J］．Chinese General Practice，2011，14（27）：3070-3072．DOI：10.3969/j.issn.1007-9572.2011.27.003.
［26］胡勇军，欧柏青.灯盏细辛注射液预防对比剂肾病的研究［J］．医学临床研究，2009，26（11）：2096-2097，2100．DOI：10.3969/j.issn.1671-7171.2009.11.041.
HU Y J，OU B Q.Study on erigeron injection for the prevention of contrast-induced nephropathy after percutaneous coronary intervention［J］．Journal of Clinical Research，2009，26（11）：2096-2097，2100．DOI：10.3969/j.issn.1671-7171.2009.11.041.
［27］MAEDER M，KLEIN M，FEHR T，et al．Contrast nephropathy：review focusing on prevention［J］．J Am Coll Cardiol，2004，44（9）：1763-1771．DOI：10.1016/j.jacc.2004.06.075.
［28］袁发焕，牟娇.造影剂肾病的发病机制与诊断及防治［J］．中国中西医结合肾病杂志，2009，10（12）：1035-1039．DOI：10.3969/j.issn.1009-587X.2009.12.001.

[1]	QUAN Jialin, ZHU Lin, SU Yu, CHEN Zekai, CHEN Ziqi, ZHANG Zhuofan. Research on the Improvement Effect of Exercise Modes on the Executive Function of Overweight or Obese Children or Adolescents: a Network Meta-analysis [J]. Chinese General Practice, 2025, 28(27): 3422-3431.
[2]	LI Hao, LI Jiangtao, LIU Dan, WANG Jianjun. Efficacy and Safety of Belimumab, Anifrolumab, and Telitacicept on the Treatment of Systemic Lupus Erythematosus: a Network Meta-analysis [J]. Chinese General Practice, 2025, 28(23): 2924-2933.
[3]	SHENG Jingyu, LIU Fanfan, MA Mei, TIAN Lin, LIU Yutong, LIU Fengmin, GAO Shan, YU Chunquan. Association between Blood Urea Nitrogen to Serum Albumin Ratio and Carotid Plaque in Patients with Coronary Heart Disease [J]. Chinese General Practice, 2025, 28(15): 1831-1839.
[4]	ZHU Shengjie, DIAO Huaqiong, HANG Xiaoyi, SUN Wenjun. Network Meta-analysis of Different Traditional Chinese Medicine Injections for the Treatment of Posterior Circulatory Ischemic Vertigo [J]. Chinese General Practice, 2025, 28(14): 1795-1808.
[5]	LIU Caiping, ZHANG Yanhua, TANG Jianpin, WANG Chengpeng, XUE Fengfeng, WANG Huijuan, LI Chuanwei, ZHANG Guangya, LI Huafang. Efficacy and Safety of Long-acting Risperidone Microspheres in the Maintenance Treatment of Schizophrenia [J]. Chinese General Practice, 2025, 28(13): 1622-1627.
[6]	CHI Xun, LIU Sisi, CHEN Qiao, HU Yue, WANG Weixian. The Suitability of Four Nutritional Screening Tools for Nutritional Screening in Patients with Cirrhosis: a Network Meta-analysis [J]. Chinese General Practice, 2025, 28(11): 1395-1402.
[7]	GU Mingyu, QIN Tingting, QIAO Kun, BAI Xinyuan, WANG Yao, YANG Yutong, LI Xingming. A Network Meta-analysis of Primary Hypertension Management Patterns in China [J]. Chinese General Practice, 2025, 28(10): 1265-1272.
[8]	GUO Jia, CAO Chunmei, LIU Guochun, ZHENG Man, ZHU Ruihan, LONG Wei. Effects of Different Exercise Types on Sleep in Insomnia Patients: a Network Meta-analysis [J]. Chinese General Practice, 2024, 27(35): 4376-4387.
[9]	ZHANG Jiateng, KONG Ming, CHEN Yu, DUAN Zhongping. Study on the Efficacy and Safety of Kuhuang Injection and Kuhuang Granules in the Sequential Treatment of Drug-induced Liver Injury: a Non-inferiority Randomized Controlled Trial [J]. Chinese General Practice, 2024, 27(26): 3249-3254.
[10]	HUANG Tengjia, CAO Xi, CHEN Lei, LI Ziying, QIN Lihua. The Effectiveness of Non-pharmacological Treatment for Post-stroke Shoulder-hand Syndrome: a Network Meta-analysis [J]. Chinese General Practice, 2024, 27(23): 2921-2930.
[11]	WANG Ting, WANG Haiyan, FU Wenjun. Effect of Chronic Atrophic Gastritis Treated with Different Acupuncture and Moxibustion Therapies: a Network Meta-analysis [J]. Chinese General Practice, 2024, 27(23): 2913-2920.
[12]	LI Mengye, JIANG Yinong. Recent Advances in Soluble Prorenin Receptor in Multisystem Diseases [J]. Chinese General Practice, 2024, 27(18): 2295-2300.
[13]	TAN Shufa, ZHANG Leichang, GAO Qiangqiang, OU Yan, HUANG Shuilan. Efficacy and Safety of Biologics and Small Molecule Drugs in the Treatment of Ulcerative Colitis: a Network Meta-analysis [J]. Chinese General Practice, 2024, 27(17): 2155-2166.
[14]	NIU Jingyuan, CHEN Huisheng, YU Jiaxiang, CUI Yu. Ligustrazine Injection in the Treatment of Acute Ischemic Stroke: a Bayesian Network Meta-analysis [J]. Chinese General Practice, 2024, 27(14): 1761-1774.
[15]	LI Qian, ZHANG Yunshu, YAN Baoping, WANG Jian, MA Yanjuan, WANG Yuan, QIN Yingjie, NA Long, REN Zhiyong, SUN Junwei, DENG Huaili, MA Hongjun, QU Xuehui, ZHOU Nan, SI Tianmei. Efficacy and Safety of Risperidone Microspheres for Injection (Ⅱ) in the Treatment of Patients with Acute Schizophrenia [J]. Chinese General Practice, 2023, 26(32): 4007-4012.