中西医结合治疗慢性肾脏病-矿物质和骨代谢异常的Meta分析

目的评价以补肾为主的中药结合西医治疗慢性肾脏病一矿物质和骨代谢异常（chronic kidney disease-mineral and bone disorder，CKD-MBD）的疗效及安全性。方法电子检索PubMed、中国知网（CNKI）、万方数据库、维普中文科技期刊数据库。收集以西医治疗为基础，加用以补肾为主要功效的中药治疗CKD-MBD的随机对照试验（RCT），评价纳入的临床研究质量，用Review Manager．2进行统计分析。结果共纳入10个RCT，496例患者。各纳入研究的质量总体较差。系统评价的结果显示，在西医治疗的基础上，加用以补肾为主要功效的中药治疗CKD-MBD，能更有效地降低甲状旁腺激素（PTH）均数差值（MD）=-36．44，95％可信区间（cI）为（-60．31，-12．56）]，而对钙MD=0．07，95％CI（-0．03，0．17）]和磷MD=0．2，95％CI（-0．41，0．02）]无显著作用。不良反应不清楚。结论在西医治疗的基础上，加用以补肾为主要功效的中药治疗CKI）-MBD，能更有效地改善CKD-MBD。但由于纳入的RCT研究方法学质量和证据强度普遍较低，其确切的临床疗效及安全性需要严格设计的大样本、多中心的随机双盲对照实验和系统评价来进一步证实。

Tonifying kidney-based Chinese traditional medicine combined with western medicine for renal osteodystrophy: A Meta-analysis

Objective To evaluate the efficacy and safety of tonifying kidney-based Chinese tra- ditional medicine combined with western medicine for chronic kidney disease-mineral and bone disorder （CKD-MBD）. Methods The randomized controlled trials （RCTs） of tonifying kidney-based Chinese traditional medicine combined with western medicine for CKD-MBD were identified from PubMed, CNKI, Wanfang Data, and VIP Data. The quality of included RCTs was assessed, and the recta-analysis was conducted with RevMan 5.2 software. Results Among 10 included RCTs involving 496 patients, the qualities of all included studies were poor. The result of Meta-analysis indicated that compared with single therapy of western medicine, tonifying kidney-based Chinese traditional medicine combined with western medicine for CKD-MBD could reduce PTH level more effectively MD = - 36. 44, 95 ~ CI （ - 60. 31, - 12. 56）]. Adverse reactions were unclear. Conclusions Compared with single therapy of western medicine, tonifying kidney-based Chinese traditional medicine combined with western medicine treatment was superior on CKD-MBD. However, the included RCTs research methodology quality and the strength of evidence are poor, so high-quality RCTs with large sample and multi-centers are re- quired to prove the above conclusion.