探讨快速评价法在检索雷公藤制剂肾毒性研究中的应用
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摘要
为了探讨快速评价法在中药肾毒性研究中的可行性,采用4种检索策略检索雷公藤制剂肾毒性的相关研究,一是不限定任何检索词,即采用传统的系统评价检索方法;二是将雷公藤制剂的相关检索词限定为"CFDA批准上市的所有包含雷公藤成分的中成药";三是将肾毒性的相关检索词限定为"前期系统评价研究文献筛选过程中发现的报道最多的与肾毒性相关的词汇";四是同时限定雷公藤制剂和肾毒性相关检索词。最后,将后3种检索方法的结果与第1种检索方法的检索结果对比。从检索到的总文献量上来看,不限制检索词的方法检索到的总文献量最多,分别限制雷公藤制剂和肾毒性检索词检索到的文献总量相对减少,同时限定者2种检索词检索到的文献总量最少。从符合纳入标准的文献量上来看,限制雷公藤制剂的方法纳入的文献数量最多。从纳入的文献类型上来看,同时限定雷公藤制剂和肾毒性相关检索词与不限定检索词的检索结果相比,符合度较高。快速评价方法在中药肾毒性的研究中应用是可行的。
To investigate the feasibility of applying the evidence-based rapid review in studying the nephrotoxicity of Tripterygium wilfordii preparation. We used four methods in relevant studies on the nephrotoxicity of T. wilfordii preparation. The first method had no limitation on any search terms,which was a traditional approach to retrieve systematic reviews. The second method limited the relevant search terms of T. wilfordii preparation to " all of CHMs containing T. wilfordii preparation approved by CFDA". The third method was to limit the relevant retrieval terms of nephrotoxicity as the " most frequently reported terms related to nephrotoxicity found in the study literature screening process in the early stage of systematic review". The fourth method was to limit the search terms relating to both T. wilfordii preparation and nephrotoxicity. Finally,the results of the last three search methods were compared with those of the first search method,and the feasibility of the rapid review method in the study for the nephrotoxicity of CHM was discussed. For the total number of literatures searched,the fourth method had the smallest number of literatures. For the number of articles in line with the inclusion criteria,the second method had the largest number of eligible literatures. For the type of literatures included,the forth method had a higher coincidence degree. The forth method was the best one,because it was not only consistent with the results,but also could minimize the workload. Rapid review is feasible in the study of nephrotoxicity of T. wilfordii.
To investigate the feasibility of applying the evidence-based rapid review in studying the nephrotoxicity of Tripterygium wilfordii preparation. We used four methods in relevant studies on the nephrotoxicity of T. wilfordii preparation. The first method had no limitation on any search terms,which was a traditional approach to retrieve systematic reviews. The second method limited the relevant search terms of T. wilfordii preparation to " all of CHMs containing T. wilfordii preparation approved by CFDA". The third method was to limit the relevant retrieval terms of nephrotoxicity as the " most frequently reported terms related to nephrotoxicity found in the study literature screening process in the early stage of systematic review". The fourth method was to limit the search terms relating to both T. wilfordii preparation and nephrotoxicity. Finally,the results of the last three search methods were compared with those of the first search method,and the feasibility of the rapid review method in the study for the nephrotoxicity of CHM was discussed. For the total number of literatures searched,the fourth method had the smallest number of literatures. For the number of articles in line with the inclusion criteria,the second method had the largest number of eligible literatures. For the type of literatures included,the forth method had a higher coincidence degree. The forth method was the best one,because it was not only consistent with the results,but also could minimize the workload. Rapid review is feasible in the study of nephrotoxicity of T. wilfordii.
引文
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[21]周艳,韩丹,牟宽厚,等.阿维A联合雷公藤及他卡西醇软膏治疗中重度银屑病的临床疗效[J].山西医科大学学报,2015,46(6):579.
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[25]赵叶.182例雷公藤多苷片不良反应分析及预防措施[J].山东中医杂志,2012,31(8):572.
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[37]徐智健.大剂量雷公藤总甙中毒致死1例[J].福建医药杂志,1991(2):2.
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[39]张剑勇,谢静静,高建华,等.昆仙胶囊联合中药辨证治疗类风湿关节炎的疗效评价[J].风湿病与关节炎,2012,1(6):14.
[40]郑洁.昆仙胶囊治疗慢性肾小球疾病的安全性研究[D].广州:广州中医药大学,2013.
[41]宁旺榕.昆明山海棠片引起不良反应1例[J].中草药,1998,29(12):823.
[2]Polisena J,Garritty C,Umscheid C A,et al.Rapid review summit:an overview and initiation of a research agenda[J].Syst Rev,2015,4(1):111.
[3]Khangura S,Polisena J,Clifford T J,et al.Rapid review:an emerging approach to evidence synthesis in health technology assessment[J].Int J Technol Assess Health Care,2014,30(1):20.
[4]Agency for Healthcare Research and Quality.EPC methods:an exploration of methods and context for the production of rapid reviews(EB/OL).[2017-01-20].https://www.cadth.ca/cadth-summit-series.
[5]Cheng C W,Bian Z X,Li Y P,et al.Transparently reporting adverse effects of traditional Chinese medicine interventions in randomized controlled trials[J].J Chin Integr Med,2008,6(9):881.
[6]曹珊,陈清萍.雷公藤多苷片联合缬沙坦治疗Ig A肾病蛋白尿的疗效[J].实用临床医学,2012,13(11):9.
[7]刘劲松,周琳,荣光辉.肾复康治疗原发性膜性肾病的临床研究[J].中国医药指南,2016,14(4):187.
[8]孙建平,高延霞,董晖.青藤碱制剂治疗慢性肾小球肾炎28例临床观察[J].临床荟萃,2007,22(16):1194.
[9]孙建平,高延霞,李琳.正清风痛宁片治疗中老年慢性肾炎临床疗效观察[J].中国老年学杂志,2007,27(22):2234.
[10]汪翠.中药加雷公藤多苷片治疗特发性膜性肾病疗效观察[D].武汉:湖北中医药大学,2015.
[11]达其伟,唐景晖,尚可儒,等.黄芪桂枝五物汤加减内服、熏蒸联合西药治疗类风湿关节炎30例[J].中医研究,2015,28(9):10.
[12]沈杰,张之澧.雷公藤多甙合小剂量甲氨蝶呤治疗老年性类风湿性关节炎[J].浙江中西医结合杂志,2002,12(6):334.
[13]郭立芳.祛风清热化瘀通络煎剂治疗类风湿性关节炎的临床研究[D].石家庄:河北医科大学,2007.
[14]黄飞霞.理肠汤、雷公藤多甙片口服和溃疡灵灌肠治疗活动期溃疡性结肠炎的临床观察[D].广州:广州中医药大学,2011.
[15]黄小玲,黄丽雅.雷公藤总内酯片治疗类风湿性关节炎的临床观察[J].广东药学院学报,2002,18(3):237.
[16]罗国良,陈用军,石年.消银汤治疗寻常型进展期银屑病临床疗效观察[J].中国现代医生,2011,49(2):43.
[17]沈瑞子,邱仁斌,邓惠文.青风藤汤治疗类风湿性关节炎45例疗效观察[J].新中医,2004,36(9):26.
[18]唐若余,宋卫珍.来氟米特、雷公藤多甙联合滋阴补血方治疗系统性红斑狼疮的疗效观察[J].中外医学研究,2014,12(35):99.
[19]章可谓.中药内服外贴联合西药治疗类风湿关节炎49例[J].中医药学报,2008,12(6):59.
[20]周德荣.搜骨清血法治疗类风湿性关节炎临床疗效观察[J].中国中医药信息杂志,2005,12(6):68.
[21]周艳,韩丹,牟宽厚,等.阿维A联合雷公藤及他卡西醇软膏治疗中重度银屑病的临床疗效[J].山西医科大学学报,2015,46(6):579.
[22]国同河.甲氨蝶呤和来氟米特及雷公藤多甙片小剂量联合应用、治疗类风湿性关节炎的临床观察[J].中华现代内科学杂志,2009,6(2):96.
[23]徐丽华.甲氨蝶呤联合来氟米特及雷公藤多甙治疗类风湿关节炎65例临床观察[J].医学信息,2010,23(11):64.
[24]谢宝官,钟文,蒙姝丽.雷公藤多甙片副作用的临床观察[J].广西医学,2002,24(4):576.
[25]赵叶.182例雷公藤多苷片不良反应分析及预防措施[J].山东中医杂志,2012,31(8):572.
[26]朱春来,罗观.甲氨蝶呤和硫酸软骨素联合雷公藤小剂量治疗类风湿关节炎临床疗效观察[J].中国社区医师:医学专业,2012,14(12):135.
[27]蔡长春.口服过量雷公藤多甙片致肾功能衰竭1例[J].临床误诊误治,1994,7(4):174.
[28]王世茹,段群录.雷公藤多甙致急性肾功能衰竭及粒细胞缺乏死亡1例[J].河北医药,1996,18(3):196.
[29]关继华.服雷公藤片过量死亡1例[J].新疆中医药,1992(4):21.
[30]关黎红,付尔康.小儿误服雷公藤多甙片引起中毒1例[J].西北药学杂志,1996,11(6):385.
[31]何满仓,李小斌,张跃,等.雷公藤制剂致肝肾损害3例[J].药物不良反应杂志,2006,8(2):136.
[32]胡成文.雷公藤急性中毒致死一例[J].安徽医学,1995,16(6):10.
[33]黄河清,程坚.口服大剂量雷公藤多甙片致急性肾功能衰竭死亡1例报告[J].河南医药信息,1996,4(6):41.
[34]潘全梅.服用过量雷公藤多甙片致中毒1例护理体会[J].实用护理杂志,1996,12(1):36.
[35]史影,王梅.雷公藤中毒致急性肾功能衰竭1例[J].中国实用内科杂志,1999,19(8):54.
[36]陆钫,张德星,田树敏.雷公藤多甙中毒引起急性肾衰一例[J].上海医学,1996,19(5):268.
[37]徐智健.大剂量雷公藤总甙中毒致死1例[J].福建医药杂志,1991(2):2.
[38]王淑芬,刘玉春,王海燕,等.雷公藤肾毒性的临床观察[J].中国中药杂志,1996,21(1):52.
[39]张剑勇,谢静静,高建华,等.昆仙胶囊联合中药辨证治疗类风湿关节炎的疗效评价[J].风湿病与关节炎,2012,1(6):14.
[40]郑洁.昆仙胶囊治疗慢性肾小球疾病的安全性研究[D].广州:广州中医药大学,2013.
[41]宁旺榕.昆明山海棠片引起不良反应1例[J].中草药,1998,29(12):823.