不同中医治法对IgA肾病疗效的Meta分析

Chinese herbal medicine for IgA nephropathy:meta-analysis of randomized controlled trials

目的 Meta分析比较不同中医治法对IgA肾病的疗效,为临床实践提供参考。方法检索国内外数据库,包括PubMed、中国生物医学数据库、CNKI数据库、维普期刊数据库、万方资源数据库等,检索时间1989年1月至2014年12月。收集单纯中医药治疗和纯西药治疗IgA肾病的随机对照实验文献,应用RevMan5.1软件进行Meta分析。结果共纳入21篇符合标准的RCT文献。中医药治疗IgA肾病的总有效率高于使用西药的对照组(RR=1.45,95%CI:1.29~1.62,P<0.01);不同中医治法亚组的临床疗效均优于西药对照组,其中益气活血法亚组(RR=1.35,95%CI:1.17~1.55);清湿热法亚组(RR=1.57,95%CI:1.24~1.98);养阴凉血化瘀法亚组的(RR=1.65,95%CI:1.30~2.10]。中医药治疗在24 h尿蛋白定量上优于西药治疗(MD=-0.26,95%CI:-0.32^-0.20,P<0.01)。中医药治疗在减少红细胞计数上优于对照组(MD=-12.80,95%CI:-19.15^-6.44,P<0.01)。结论不同中医治法对于IgA肾病疗效显著,但仍需要多中心、大样本的高质量随机对照试验进一步研究。

Objective Traditional Chinese medicine（TCM） is widely used for treatment of IgA nephropathy（IgAN）, but there is no meta-analysis of treatment based on syndrome differentiation of Ig AN. Objectives To evaluate effects of Chinese herbal medicine（CHM） on IgAN. Methods Systematic review methods combining meta-analysis with subgroup meta-analysis were used to explore the effects of heterogeneity in clinical therapeutic efficacy. We performed comprehensive searches on the following databases ： MEDLINE, Cochrane Library, CNKI, CBM, Wangfang, and VIP up to December 2014. Results 21 randomized IgAN control trails and 1 532 patients were selected for the study. Patients with Ig AN treated with TCM had a higher probability of symptom relief compared with those treated with Western medicine（RR = 1.45, 95% CI 1.29 to 1.62）. CHM was more effective in reducing 24-hour urinary protein（mean difference（MD =-0.26; 95 CI-0.32 to-0.20）. Meta-analysis indicated TCM was superior to Western medicine in decreasing urinary red blood cell count（MD=12.80, 95% CI 19.15 to 6.44,P〈0.01）. Subgroup analyses of different TCM therapies showed significant differences between comparisons with Western medicine（P〈0.01）. No serious adverse events were reported. Conclusion CHM seems to be an effective and safe option to treat patients with IgAN. However,more multicenter, large-scale, double-blind RCTs worldwide are needed to provide a higher level of evidence.