健脾益肾法治疗特发性膜性肾病的Meta分析

Meta-analysis of Strengthening Spleen and Tonifying Kidney Method in Treatment ofIdiopathic Membranous Nephropathy

目的系统评价健脾益肾法治疗特发性膜性肾病的有效性和安全性。方法检索中国知网、万方、维普、CBM、Pubmed、the Cochrane Library、Web of Science等医学数据库建库至2018年12月的数据。根据纳入、排除标准确定文献后,参照Cochrane Collaboration标准和Jadad质量评分法进行检索和对纳入的文献进行质量评价,应用RevMan 5.3软件进行统计分析。结果根据检索结果和纳入排除标准,最终纳入13篇文献研究,共805例患者。Meta分析结果显示:健脾益肾法为主的试验组治疗IMN比单纯西医治疗组的临床总有效率[OR=3.38,95%CI(2.32,4.92),P<0.00001]更高,在降低患者的24 h UTP[MD=-0.82,95%CI(-1.01,-0.63),P<0.00001]、Scr[MD=-4.53,95%CI(-7.96,-1.10),P<0.00001]、TC[MD-0.95,95%CI(-1.15,-0.75),P<0.00001]、TG[MD=-0.54,95%CI(-0.86,-0.22),P<0.00001]及升高ALB[MD=3.58,95%CI(2.31,4.84),P<0.00001]方面,疗效均优于对照组,且安全性更高[OR=0.34,95%CI(0.16,0.72),P=0.005<0.05],差异均具有统计学意义,但在降低BUN方面[MD=-0.56,95%CI(-1.88,0.76),P<0.00001]与对照组疗效相当。结论健脾益肾法治疗特发性膜性肾病安全有效,且优于单纯西医治疗。由于纳入研究文献质量较低,潜在疗效尚需高质量的随机对照试验加以证实。

Objective To systemically review the efficacy and safety of strengthening spleen and tonifying kidney method in the treatment of idiopathic membranous nephropathy.Methods We retrieved a variety of medical journals until December 2018.According to the inclusion and exclusion criteria,the quality of retrieval literature was evaluated according to Cochrane Collaboration standard and Jadad quality score method,and RevMan5.3 software was used for statistical analysis.Results According to inclusion and exclusion criteria,a total of 13 RCTs were included,totally 805 patients.Meta-analysis results showed there was statistically significant difference between strengthening spleen and tonifying kidney method and the western medicine treatment alone when combining trials in clinical effective rate[OR=3.38,95%CI(2.32,4.92),P<0.00001],decreasing 24 h UTP[MD=-0.82,95%CI(-1.01,-0.63),P<0.00001],Scr[MD=-4.53,95%CI(-7.96,-1.10),P<0.00001],TC[MD=-0.95,95%CI(-1.15,-0.75),P<0.00001],TG[MD=-0.54,95%CI(-0.86,-0.22),P<0.00001]and increasing ALB[MD=3.58,95%CI(2.31,4.84),P<0.00001].The curative effect was better than that of the control group,and the safety was higher[OR=0.34,95%CI(0.16,0.72),P=0.005<0.05].However,there was no statistically significant difference between strengthening spleen and tonifying kidney method and the western medicine treatment alone when combining trials in BUN[MD=-0.56,95%CI(-1.88,0.76),P<0.00001].Conclusion The method of strengthening spleen and tonifying kidney is safe and effective in the treatment of idiopathic membranous nephropathy,and is superior to that of western medicine alone.Due to the low quality of the included literature,the potential efficacy needs to be confirmed by high-quality randomized controlled trials.