雷公藤多苷辅助治疗狼疮性肾炎的Meta分析

Meta-analysis of Tripterygium Glycosides in The Treatment of Lupus Nephriti

目的:系统评价雷公藤多苷联合西药治疗狼疮性肾炎(LN)的疗效。方法:计算机检索2009—2019年中国知网、维普数据库、万方数据库、PubMed数据库及Springer电子期刊,查找以雷公藤多苷联合西药治疗LN的随机对照试验(RCT),按纳入标准和排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用Revman5.3软件进行Meta分析。结果:1)共纳入8篇文章,657例患者,其中观察组330例,对照组327例,各研究均明确指出基线均衡,具有可比性。2)Meta分析结果显示:雷公藤多苷辅助治疗LN在提高缓解率(OR=1.58,95%CI[1.08,2.32],P=0.02),降低血尿素氮(MD=-1.14,95%CI[-2.13,-0.14],P=0.03),降低血肌酐(MD=-9.93,95%CI[-17.94,-1.93],P=0.02),提升血清白蛋白(MD=3.99,95%CI[0.82,7.17],P=0.01),增加补体C3(MD=0.16,95%CI[0.05,0.27],P=0.003),增加补体C4(MD=0.09,95%CI[-0.03,0.15],P=0.003)等方面明显优于单用激素或免疫抑制剂等西药治疗,其差异有统计学意义。在降低24 h尿蛋白及发生不良反应等方面无统计学意义。结论:本次Meta分析显示雷公藤多苷辅助治疗LN对比单纯使用西药(激素、免疫抑制剂、细胞毒性药物),在提高缓解率,升高血清白蛋白,降低血尿素氮、血肌酐及提高补体C3、C4方面疗效突出,差异均有统计学意义。但由于此次收录的文献质量相对不高,样本数量较少,未来更需要更多高质量,大样本,研究设计方案更严谨的随机对照试验,对雷公藤多苷辅助治疗LN有更精确的评估。

Objective:To systematically evaluate the efficacy of tripterygium wilfordii glycosides combined with Western medicine in the treatment of lupus nephritis.Methods:Computers were searched in CNKI,VIP database,Wanfang database,PubMed database and Springer electronic journal to find the randomized controlled trials(RCT)for the treatment of lupus nephritis with the combination of ripterygium wilfordii glycosides and Western medicine agents.After according to inclusion and exclusion criteria we screened the literature,extracted the data,and evaluated the methodological quality of the studies included,meta-analysis was performed in Revman 5.3 software.Results:1)A total of 8 papers were included,including 330 patients in the observation group and 327 in the control group.All studies clearly indicated baseline balance and were comparable.2)Meta analysis results showed that tripterygium glycosides can improve remission rate(OR=1.58,95%CI:[1.08,2.32],P=0.02),reduce blood urea nitrogen(MD=-1.14,95%CI[-2.13,-0.14],P=0.03)and serum creatinine(MD=-9.93,95%CI[-17.94,-1.93],P=0.02),increase serum albumin(MD=3.99,95%CI[0.82,7.17],P=0.01),increase C3(MD=0.16,95%CI[0.05,0.27],P=0.003)and increase C4(MD=0.09,95%CI[-0.03,0.15],P=0.003)and other aspects,which were significantly better than treatment with single Western medicine such as hormones or immunosuppressants,and the difference is statistically significant.There was no statistical significance in reducing 24 h urine protein and occurrence of adverse reactions.Conclusion:Meta-analysis showed that tripterygium glycosides as an adjuvant treatment of lupus nephritiscan in terms of improving remission rate increasing serum albumin and reducing blood urea nitrogen,serum creatinine and increasing complement C3 and C4 is better,compared with the Western medicine,the differences are statistically significant.However,due to the literature included with lower quality and the small number of samples,randomized controlled trials with more rigorous research design schemes,more higher-quality and larger samples will be needed in the future and more accurate assessment in the treatment of lupus nephritis with triptolide polyglycosides will be needed.