Zhang Hong Wei, Lin Zhi Xiu, Tung Yuk Stewart, Kwan Tze Hoi, Mok Chun Keung, Leung Connie, Chan Lai Sum
School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China.
Cochrane Database Syst Rev. 2014 Dec 18;2014(12):CD008353. doi: 10.1002/14651858.CD008353.pub2.
Cordyceps sinensis (Cordyceps, Dong Chong Xia Cao), a herbal medicine also known as Chinese caterpillar fungus, is one of the most commonly used ingredients in traditional Chinese medicine for the treatment of people with chronic kidney disease (CKD).
This review aimed to evaluate the therapeutic effects and potential adverse effects of Cordyceps sinensis for the treatment of people with CKD.
We searched the Cochrane Renal Group's Specialised Register to 14 April 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We also searched CINAHL, AMED, Current Controlled Trials, OpenSIGLE, and Chinese databases including CBM, CMCC, TCMLARS, Chinese Dissertation Database, CMAC and Index to Chinese Periodical Literature.
Randomised and quasi-randomised trials comparing Cordyceps or its products with placebo, no treatment, or conventional treatment were considered for inclusion in the review.
Two authors independently assessed data quality and extracted data. Statistical analyses were performed using the random-effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).
We included 22 studies that involved 1746 participants. Among people with CKD who were not receiving dialysis, Cordyceps preparations were found to significantly decrease serum creatinine (14 studies, 987 participants): MD -60.76 μmol/L, 95% CI -85.82 to -35.71); increase creatinine clearance (6 studies, 362 participants): MD 9.22 mL/min, 95% CI 3.10 to 15.34) and reduce 24 hour proteinuria (4 studies, 211 participants: MD -0.15 g/24 h, 95% CI -0.24 to -0.05). However, suboptimal reporting and flawed methodological approaches meant that risk of bias was assessed as high in four studies and unclear in 18 studies, and hence, these results need to be interpreted with caution.
AUTHORS' CONCLUSIONS: We found that Cordyceps preparation, as an adjuvant therapy to conventional medicine, showed potential promise to decrease serum creatinine, increase creatine clearance, reduce proteinuria and alleviate CKD-associated complications, such as increased haemoglobin and serum albumin. However, definitive conclusions could not be made because of the low quality of evidence.
冬虫夏草，一种也被称为中华虫草菌的草药，是治疗慢性肾脏病（CKD）患者最常用的传统中药成分之一。
本综述旨在评估冬虫夏草治疗CKD患者的疗效及潜在不良反应。
我们通过与试验检索协调员联系，使用与本综述相关的检索词，检索了截至2014年4月14日的Cochrane肾脏组专业注册库。我们还检索了CINAHL、AMED、当前对照试验、OpenSIGLE以及中文数据库，包括中国生物医学文献数据库（CBM）、中国医学科普文献数据库（CMCC）、中医药学文献数据库（TCMLARS）、中国学位论文数据库、中国学术会议论文数据库（CMAC）和中国期刊全文数据库。
比较冬虫夏草及其产品与安慰剂、无治疗或传统治疗的随机和半随机试验被纳入本综述。
两位作者独立评估数据质量并提取数据。采用随机效应模型进行统计分析，结果以二分变量的风险比（RR）或连续数据的均值差（MD）表示，并给出95%置信区间（CI）。
我们纳入了22项研究，涉及1746名参与者。在未接受透析的CKD患者中，发现虫草制剂可显著降低血清肌酐（14项研究，987名参与者）：MD -60.76 μmol/L，95% CI -85.82至-35.71）；增加肌酐清除率（6项研究，362名参与者）：MD 9.22 mL/min，95% CI 3.10至15.34）并减少24小时蛋白尿（4项研究，211名参与者：MD -0.15 g/24 h，95% CI -0.24至-0.05）。然而，报告不充分和方法学存在缺陷意味着四项研究的偏倚风险被评估为高，18项研究的偏倚风险不明确，因此，这些结果需要谨慎解释。
我们发现，作为传统药物的辅助治疗，虫草制剂在降低血清肌酐、增加肌酐清除率、减少蛋白尿以及缓解CKD相关并发症（如提高血红蛋白和血清白蛋白）方面显示出潜在前景。然而，由于证据质量低，无法得出明确结论。
