中医药分阶段论治对糖皮质激素治疗原发性肾病综合征疗效的系统评价

System evaluation on efficacy of TCM phased treatment for glucocorticoid therapy of primary nepherotic syndrome

目的:评价中医药分阶段论治对糖皮质激素(GC)治疗原发性肾病综合征(PNS)是否有助于疗效的提高。方法:按照系统评价的要求电子检索1978年-2012年PubMed、Cochrane图书馆、CBMdisc、CNKI、万方数据库等中收录的文献,手工检索《中西医结合杂志》及国内肾脏疾病相关的杂志,比较搜集的临床随机对照试验(RCT)。由2名评价员独立筛选、评价文献和提取数据。采用RevMan 5.0软件进行数据分析。结果:GC配合中医药分阶段论治组与GC组相比,前者总缓解率高于后者(OR=5.24,95%CI[3.54,7.74]),前者治疗12个月后复发率低于后者(OR=0.28,95%CI[0.14,0.58]),前者激素不良反应发生率低于后者(OR=0.22,95%CI[0.15,0.33])。总缓解率及激素不良反应发生率"漏斗图"图形基本对称。结论:中医药分阶段论治对GC治疗PNS在提高疗效、减少复发及减轻激素毒副作用方面具有较好的作用。

Objective： To evaluate whether or not the phased treatment of traditional Chinese medicine is benefit to the improvement of curative effect of glucocorticoid （GC） treatment of primary nephrotic syndrome （PNS）. Methods： According to the requirements of system evaluation, a thorough literature search was performed electronic retrieval among PubMed, Cochrane library, CBMdisc, CNKI, Wanfang Data etc, and manual search was performed among Integrative Medicine Journal and journals relevant the kidney disease in China. Randomized controlled trials were performed to compare. Two qualified reviewers screened and evaluated the documents, extracted data independently. Data were analyzed by using the RevMan 5.0 software. Results： Compared to the GC group, in GC combine the phased treatment of traditional Chinese medicine group, the overall remission rate was higher （OR=5.24, 95%CI[3.54, 7.74]）, the relapse rate after 12 months of treatment was lower （OR=0.28, 95%CI [0.14, 0.58]）, and hormone adverse reaction rates was lower （OR=0.22, 95%CI[0.15, 0.33]）. The funnel plot graphics of these were basically symmetrical. Conclusion： The phased treatment of traditional Chinese medicine has a good effect to improve efficacy, reduce recurrence and alleviate the hormonal side effects for GC treatment of PNS.