口服中成药联合常规西药治疗肾性贫血的网状Meta分析*

作者：许政通1，辛世龙1，刘恒君1，客 蕊2

单位：1.黑龙江中医药大学，黑龙江 哈尔滨 150040； 2.黑龙江中医药大学附属第一医院，黑龙江 哈尔滨 150040

引用：引用：许政通，辛世龙，刘恒君，客蕊.口服中成药联合常规西药治疗肾性贫血的网状Meta分析[J].中医药导报,2026,32(5):210-219.

DOI：10.13862/j.cn43-1446/r.2026.05.033

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摘要：

目的：运用网状Meta分析对不同口服中成药联合常规西药治疗肾性贫血（RA）的疗效和安全性进行评价。方法：检索中国知网（CNKI）、万方数据知识服务平台（Wanfang Data）、维普中文期刊服务平台、中国生物医学文献服务系统（SinoMed）、PubMed、Cochrane Library、EMbase、Web of Science，从建库至2025年2月21日收录的口服中成药联合常规西药治疗RA的随机对照试验（RCTs）文献，运用Cochrane风险偏倚评估工具对纳入文献进行质量评价，采用RevMan 5.4、Stata 16软件进行数据分析。结果：共纳入47篇RCTs文献，包含阿芪补血颗粒、补脾益肾升血丸、归脾丸、黑地黄丸、健脾生血颗粒、健脾生血片、金水宝片、生血宝合剂、生血宁片共9种口服中成药，结合网状Meta分析及累计概率排名曲线下面积（SUCRA）排序结果显示，口服中成药联合常规西药在提高血红蛋白浓度、红细胞比容、红细胞计数、血清铁蛋白、转铁蛋白饱和度方面均优于常规西药，差异均有统计学意义（P＜0.05）。提高血红蛋白浓度，排序最优的为健脾生血片+常规西药[SMD=1.58，95%CI（1.00，2.15）]；提高红细胞比容，排序最优的为生血宁片+常规西药[SMD=1.64，95%CI（1.15，2.13）]；提高红细胞计数，排序最优的为金水宝片+常规西药[SMD=3.48，95%CI（1.60，5.36）]；提高血清铁蛋白，排序最优的为健脾生血片+常规西药[SMD=3.77，95%CI（1.69，5.86）]；提高转铁蛋白饱和度方面，排序最优的为健脾生血片+常规西药[SMD=1.77，95%CI（1.14，2.40）]。安全性方面，中成药联合常规西药的不良事件以胃肠道反应、血压异常为主。通过进行偏倚风险评价，大多数为低风险。结论：口服中成药联合常规西药治疗RA能够提高综合疗效，调节红细胞参数和铁代谢情况，改善肾功能。但由于纳入文献样本量及质量等限制，结论有待更多大样本、高质量的研究加以验证。

关键词：肾性贫血；中成药；网状Meta分析；慢性肾脏病

Abstract：

Objective: To evaluate the efficacy and safety of different oral Chinese patent medicines combined with conventional western medicine in the treatment of renal anemia (RA) using network Meta-analysis. Methods: Databases including China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (Wanfang Data), China Science and Technology Journal Database (CSTJ), Chinese Biomedical Literature Service System (SinoMed), PubMed, Cochrane Library, EMbase and Web of Science were searched for randomized controlled trials (RCTs) of oral Chinese patent medicines combined with conventional western medicine for RA from the establishment of the databases to February 21, 2025. The Cochrane risk of bias assessment tool was used to evaluate the quality of included literature, and RevMan 5.4 and Stata 16 software were adopted for data analysis. Results: A total of 47 RCTs were included, involving 9 kinds of oral Chinese patent medicines: Aqi Buxue Granules (阿芪补血颗粒), Bupi Yisheng Shengxue Pills (补脾益肾升血丸), Guipi Pills (归脾丸), Hei Dihuang Pills (黑地黄丸), Jianpi Shengxue Granules (健脾生血颗粒), Jianpi Shengxue Tablets (健脾生血片), Jinshuibao Tablets (金水宝片), Shengxuebao Mixture (生血宝合剂) and Shengxuening Tablets (生血宁片). Network Meta-analysis and surface under the cumulative ranking curve (SUCRA) showed that oral Chinese patent medicines combined with conventional western medicine were superior to conventional western medicine alone in increasing hemoglobin level, hematocrit, red blood cell count, serum ferritin and transferrin saturation, with statistically significant differences (P<0.05). For hemoglobin elevation, Jianpi Shengxue Tablets + conventional Western medicine ranked first [SMD=1.58, 95%CI(1.00, 2.15)], for hematocrit elevation, Shengxuening Tablets + conventional western medicine ranked first [SMD=1.64, 95%CI(1.15, 2.13)], for red blood cell count elevation, Jinshuibao Tablets + conventional western medicine ranked first [SMD=3.48, 95%CI(1.60, 5.36)], for serum ferritin elevation, Jianpi Shengxue Tablets + conventional western medicine ranked first [SMD=3.77, 95%CI(1.69, 5.86)], for transferrin saturation elevation, Jianpi Shengxue Tablets + conventional western medicine ranked first [SMD=1.77, 95%CI(1.14, 2.40)]. In terms of safety, adverse events of Chinese patent medicines combined with western medicine were mainly gastrointestinal reactions and abnormal blood pressure. Most included studies were at low risk of bias. Conclusion: Oral Chinese patent medicines combined with conventional western medicine can improve the comprehensive efficacy, regulate red blood cell parameters and iron metabolism, and improve renal function in patients with RA. However, due to limitations in sample size and quality of included literature, the conclusions need to be verified by more large-sample and high-quality studies.

Key words：renal anemia; Chinese patent medicines; network Meta-analysis; chronic kidney disease

发布时间：2026-05-24

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