雷公藤多苷治疗成人IgA肾病的系统评价和meta分析

Systematic review and meta-analysis of Tripterygium wilfordii multiglucoside in the treatment of adult IgA nephropathy

目的系统评价雷公藤多苷(TWM)治疗IgA肾病(IgAN)的临床效果和安全性。方法计算机检索EMbase、The Cochrane Library、PubMed、CNKI、CBM、万方和维普数据库自建库至2019年10月所有公开发表的关于TWM治疗IgAN的随机对照试验。由两位研究员独立筛选文献、提取资料及评估偏倚风险后,采用RevMan 5.3软件进行meta分析。结果共纳入20项研究,试验组729例,对照组685例。meta分析结果显示:试验组在降低IgAN患者24 h尿蛋白定量(MD=-0.57,95%CI:-0.71^-0.42,P<0.00001)、血肌酐(MD=-9.26,95%CI:-13.09^-5.44,P<0.00001)、尿转化生长因子-β1水平(MD=-1.67,95%CI:-1.92^-1.41,P<0.00001)及升高临床总有效率(RR=1.35,95%CI:1.26~1.45,P<0.00001)、血清白蛋白(MD=3.03,95%CI:1.67~4.38,P<0.0001)方面疗效均优于对照组,但两组总不良反应发生率比较差异无统计学意义(RR=1.14,95%CI:0.84~1.53,P=0.40)。结论TWM用于IgAN的治疗可提高临床效果,且安全性较好。受纳入研究质量所限,上述结论尚待更多高质量研究加以论证。

Objective To evaluate clinical efficacy and safety of Tripterygium wilfordii multiglucoside(TWM)in the treatment of IgA nephropathy(IgAN).Methods EMbase,The Cochrane Library,PubMed,CNKI,CBM,Wanfang and VIP databases were searched for all published randomized controlled trials on the treatment of IgAN with TWM from the establishment of the databases to October 2019.After the two researchers screened the literature,extracted the data and assessed the risk of bias independently,the RevMan 5.3 software was used for meta-analysis.Results A total of 20 studies were included,including 729 cases in experimental group and 685 cases in control group.The results of meta-analysis showed that the experimental group was better than control group in decreasing 24 h urinary protein(MD=-0.57,95%CI:-0.71 to-0.42,P<0.00001),serum creatinine(MD=-9.26,95%CI:-13.09 to-5.44,P<0.00001),urinary transforming growth factor-β1(MD=-1.67,95%CI:-1.92 to-1.41,P<0.00001)and increasing clinical total effective rate(RR=1.35,95%CI:1.26 to 1.45,P<0.00001),serum albumin(MD=3.03,95%CI:1.67 to 4.38,P<0.0001).There was no significant difference in the incidence of adverse reactions between two groups(RR=1.14,95%CI:0.84 to 1.53,P=0.40).Conclusion TWM for the treatment of IgAN can improve clinical efficacy and the safety is relatively good.Due to limited quantity of the included studies,more high quality studies are required to verify the conclusion mentioned above.