| ObjectiveTo explore the clinical efficacy and safety of Nuiduqing Granules on the disorder of calcium and phosphorus metabolism in patients with chronic renal failure(CRF)by using the method of Meta analysis,so as to provide evidence for clinical application.MethodThe Chinese and foreign language databases were retrieved by computer,including CNKI,VIP,CBM,EMBASE,Pub Med,Cochrane Library and Web of Science.The dates were from the establishment to January 1,2021.Manually retrieve the dissertation,ournal of Traditional Chinese Medicine,Chinese Journal of Integrated Traditional Chinese and Western Medicine,Chinese Journal of Nephropathy of Integrated Traditional Chinese and Western Medicine,Journal of Clinical Kidney Disease,Journal of Practical Traditional Chinese Medicine.To retrieve the literature of randomized controlled trials on the treatment of calcium and phosphorus metabolism disorder in patients with chronic renal failure by Nuiduqing granules;The literature will be screened by two trained researchers,and if there is a disagreement,the supervisor will judge.The improved Jadad scale and Cochrane systematic evaluation manual were used to evaluate the quality of the selected articles.Rev Man 5.4 software was used to Meta-analyze the changes of the experimental indexes in the included literature: serum calcium concentration,serum phosphorus concentration,parathyroid hormone concentration,serum calcium phosphorus product,serum creatinine,urea nitrogen,albumin,serum creatinine clearance,glomerular filtration rate,KT/V,and the incidence of adverse reactions.ResultA total of 1683 patients were included in 23 articles,including 842 patients in the experimental group treated with Nuiduqing granules combined with Western medicine,and 841 patients in the control group treated with Nuiduqing granules alone without Western medicine.Nineteen of the studies included hemodialysis patients and two included peritoneal dialysis patients.Two studies were conducted on non-hemodialysis patients at stage 3-4 of chronic renal failure,so they were first divided into three subgroups for the combination of experimental data.The results of Meta-analysis showed that:(1)in the hemodialysis group,there were 17 studies on the changes of serum calcium concentration in hemodialysis patients.The MD of the experimental group was0.22,95%CI(0.13,0.31),Z=4.81(P < 0.00001).The experimental group was better than the control group in increasing serum calcium level,and the difference was statistically significant,indicating that Nuiduqing granules could improve the serum calcium concentration in hemodialysis patients.There were 18 literatures on the influence of studies on blood phosphorus concentration.The results showed that the experimental group reduced blood phosphorus concentration in patients with MD=-0.29,95%CI(-0.34,-0.23),Z =10.77(P<0.00001)].The experimental group was better than the control group in reducing blood phosphorus level,and the difference was statistically significant,indicating that Nuiduqing granules could reduce blood phosphorus concentration in patients with hemodialysis.There were 17 studies on the changes of parathyroid hormone concentration in patients with hemodialysis.The experimental group reduced the concentration of parathyroid hormone(SMD)=-1.58,95%CI(-1.9,-1.27),Z=9.87(P< 0.00001).The experimental group was better than the control group in reducing the concentration of parathyroid hormone,and the difference was statistically significant,indicating that Niduqing Granulation could inhibit hyperparathyroidism in patients with hemodialysis.There were 3 studies on the changes of serum calcium-phosphorus product in hemodialysis patients.Intheexperimentalgroup,the Md=-0.35,95%CI(-1.08,-0.37),Z=0.95(P= 0.34> 0.05)were decreased,and the differences were not statistically significant.Research hemodialysis patients serum creatinine concentration changes of eight articles,experimental group to reduce the concentration of serum creatinine [MD=-36.09,95%CI(-45.41,-26.76),Z=7.59(P<0.00001),the experimental group is better than that of control group in terms of lower serum creatinine levels,the difference was statistically significant,that uric poisonous clear particles can reduce serum creatinine concentration of hemodialysis patients,and study of hemodialysis patients blood urea nitrogen concentration change 7 articles,M D=-5.69,95%CI(-6.46,-4.92),Z=14.51(P<0.00001),the experimental group was better than the control group in reducing the blood urea nitrogen level,the difference was statistically significant,indicating that Nuiduqing granules can reduce the blood urea nitrogen concentration of hemodialysis patients.Study on the influence of serum creatinine clearance rate in hemodialysis patients There were 2 literatures in which the experimental group increased the serum creatinine clearance rate MD=2.34,95%CI(1.1,3.58),Z=3.69(P=0.0002).The experimental group was better than the control group in improving the serum creatinine clearance rate,and the difference was statistically significant,indicating that Nuiduqing granules could improve the serum creatinine clearance rate of hemodialysis patients.Peritoneal dialysis group: There are two papers,Treatment group in improving the blood calcium concentration [MD = 0.30,95% CI(0.17,0.43),Z = 4.26(P < 0.0001)],reduce blood phosphorus concentration MD = 0.49,95% CI(0.66,0.33),Z = 5.75(P < 0.00001),reduce the concentration of parathyroid hormone [MD = 2.63,95% CI(4.2,1.06),Z = 3.29(P = 0.001)],increase albumin concentration[MD = 6.06,95% CI(2.07,10.05),Z = 2.9 8(P=0.003)],the results showed that the experimental groups were better than the control group,and the difference was statistically significant,indicating that the Nuiduqing granules had a significant effect on increasing serum calcium,decreasing serum phosphorus,decreasing parathyroid hormone and increasing albumin in patients with chronic renal failure peritoneal dialysis.CKD stage 3-4 non-dialysis group: There were 2 literatures in total,in which the experimental group was better than the control group in reducing serum calcium concentration [Md =-1.61,95%CI(-2.89,-0.33),Z=2.46(P=0.01 <0.05)],reducing blood urea nitrogen concentration Md=-1.98,95%CI(-2.58,-1.38),Z=6.49(P < 0.00001),and improving glomerularfiltrationrate Md=3.47,95%CI(0.82,6.12),Z=2.57(P=0.01 < 0.05),and the difference was statistically significant.The results showed that Nuduqing granules had obvious effect on reducing serum calcium concentration,reducing urea nitrogen concentration and improving glomerular filtration rate in non-dialysis group of chronic renal failure CKD stage3-4.ConclusionNuiduqing Granule has obvious curative effect on calcium and phosphorus metabolism disorder in patients with chronic renal failure,and it is safe,convenient to take,and suitable for clinical application.However,due to the low quality of the included literature and small sample size in this study,there is a risk of bias. |
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