评价黄芪注射液联合水化治疗预防对比剂肾病的临床疗效和安全性：一项荟萃分析

Evaluating the Clinical Efficacy and Safety of Astragalus Injection Combined with Hydration Therapy in Preventing Contrast-Induced Nephropathy: A Meta-Analysis

摘要: 背景：对比剂肾病(Contrast-Induced Nephropathy, CIN)是临床上常见的一种急性肾损伤，通常发生在接受造影剂注射的患者身上。尽管传统的水化疗法已被广泛用于预防CIN，但其有效性仍有局限性。近年来，黄芪注射液因其潜在的肾保护作用而备受关注。本研究旨在系统评估黄芪注射液联合水化疗法预防CIN的临床疗效和安全性。方法：本系统评价和Meta分析遵循Cochrane协作组织的方法指南，通过检索PubMed、EMbase、CochraneLibrary、中国生物医学文献数据库、中国知网、维普和万方数据库，收集黄芪注射液联合常规水化疗法预防CIN的随机对照试验(RCT)。纳入研究的方法学质量由Cochrane 5.1偏倚风险评估工具进行评估，数据提取和Meta分析由RevMan 5.4.1软件完成。结果：共纳入4项RCT，覆盖252例患者。Meta分析表明，与单独使用水化疗法相比，黄芪注射液联合水化疗法在预防CIN方面可显著降低CIN的发生率(OR = 0.34, 95% CI [0.12, 0.94], P < 0.05)，并在改善术后肾功能指标方面具有明显优势。所有研究均未报告不良事件。虽然漏斗图显示了发表偏倚的可能性，但敏感性分析和漏斗图方法分析的结果证实了研究结果的稳定性和可靠性。结论：黄芪注射液联合水化疗法在预防对比剂肾病方面具有良好的临床疗效和安全性。然而，鉴于现有证据的局限性，仍需要更多高质量、多中心、大规模的随机对照研究来验证这一发现，并为临床应用提供更坚实的证据基础。

Abstract: Background: Contrast-Induced Nephropathy (CIN) is a common clinical form of acute kidney injury that usually occurs in patients receiving contrast injections. Although conventional hydration therapy has been widely used to prevent CIN, there are limitations to its effectiveness. In recent years, Astragalus injection has attracted attention for its potential nephroprotective effects. The aim of this study was to systematically evaluate the clinical efficacy and safety of Astragalus injection combined with hydration therapy for the prevention of CIN. Methods: This systematic evaluation and Meta-analysis followed the methodological guidelines of the Cochrane Collaboration, and randomised controlled trials (RCTs) comparing Astragalus injection in combination with conventional hydration therapy (experimental group) against conventional hydration therapy alone (control group) for the prevention of CIN were collected by searching PubMed, EMbase, CochraneLibrary, China Biomedical Literature Database, CNKI, VIP and Wanfang databases. The methodological quality of the included studies was assessed by the Cochrane 5.1 risk of bias assessment tool, and data extraction and Meta-analysis were done by RevMan 5.4.1 software. Results: A total of 4 RCTs covering 252 patients were included. Meta-analysis showed that Astragalus injection combined with hydration therapy significantly reduced the incidence of CIN in preventing CIN compared with hydration therapy alone (OR = 0.34, 95% CI [0.12, 0.94], P < 0.05), and had a significant advantage in improving postoperative renal function indices. No adverse events were reported in any of the studies. Although the funnel plot showed the possibility of publication bias, the results of sensitivity analysis and funnel plot method analysis confirmed the stability and reliability of the study results. Conclusion: Astragalus injection combined with hydration therapy has good clinical efficacy and safety in preventing contrast nephropathy. However, given the limitations of the available evidence, more high-quality, multicentre, large-scale randomised controlled studies are still needed to validate this finding and provide a stronger evidence base for clinical application.