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中药复方联合激素免疫抑制剂治疗膜性肾病的系统评价和Meta分析 被引量:9

Therapeutic efficacy of traditional Chinese medicine compound in the treatment of membranous nephropathy:A systematic review and meta-analysis
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摘要 目的:系统评价在使用激素和免疫抑制剂治疗的基础上加用中药复方治疗膜性肾病(membranous nephropathy,MN)的临床疗效。方法:计算机检索中国知网,万方数据库,维普数据库、中国生物医学数据库、PubMed、Embase、Cochrane数据库,收集有关中药复方+激素+免疫抑制剂治疗MN的临床研究,删除重复文献,通过阅读题目、摘要及全文剔除不符合纳入与排除标准的文献,对纳入文献进行数据提取,使用RevMan软件进行Meta分析。结果:使用频率前6的中药分别是黄芪、茯苓、白术、丹参、当归和山药,补虚药和活血化瘀药使用较多。在使用激素和免疫抑制剂治疗的基础上使用中药复方治疗MN患者,可提高临床疗效[OR=2.90,95%CI(2.27,3.70),P<0.00001]和中医症候疗效[OR=3.10,95%CI(1.91,5.05),P<0.00001],改善中医症候积分[SMD=-0.93,95%CI(-1.34,-0.52),P<0.00001],降低24 h尿蛋白水平[SMD=-0.90,95%CI(-1.23,-0.57),P<0.00001],提高血浆白蛋白水平[SMD=1.22,95%CI(0.86,1.58),P<0.00001],降低血脂TC水平[SMD=-0.69,95%CI(-0.98,-0.39),P<0.00001],降低血脂TG水平[SMD=-0.75,95%CI(-1.09,-0.41),P<0.0001],改善肾功能BUN水平[SMD=-0.56,95%CI(-0.97,0.14),P=0.008]和Scr水平[SMD=-0.58,95%CI(-0.89,-0.27),P=0.0002],减少不良反应的发生率[OR=0.32,95%CI(0.22,0.44),P<0.00001]。Egger和harbord检验结果提示部分指标存在发表偏倚。结论:所用中药以黄芪为主,益气活血中药使用较频繁。在使用激素+免疫抑制剂的基础应用益气活血中药治疗MN效果较好,但限于纳入文献质量不高,结论有待更多高质量研究加以验证。 Objective To systematically evaluate the clinical efficacy of traditional Chinese medicine combined with traditional Chinese medicine in the treatment of membranous nephropathy(MN)based on hormones and immunosuppressive agents.Methods Computer search of China Knowledge Network,Wanfang Database,Weipu Database,China Biomedical Database,PubMed Database,Embase Database,Cochrane Database was used to collect clinical research on Chinese medicine compound+hormone+immunosuppressive therapy for MN.duplicate literature was deleted and non-conformity was eliminated by reading topic and abstract and full text.The literature was included in the exclusion criteria,the data was extracted from the included literature,and the meta-analysis was performed using the stata14.0 software package.Results The top 6 Chinese medicines used were Astragalus,Poria,Atractylodes,Salvia,Angelica and Chinese Yam.The use of traditional Chinese medicine in the treatment of patients with MN on the basis of hormone and immunosuppressive therapy can improve clinical efficacyOR=2.90,95%CI(2.27,3.70,P<0.00001 and TCM symptom efficacy OR=3.10,95%CI(1.91,5.05),P<0.00001,improved TCM syndrome scores SMD=-0.93,95%CI(-1.34,-0.52),P<0.00001,reduced 24-hour urine protein levels SMD=-0.90,95%CI(-1.23,-0.57),P<0.00001,increased plasma albumin levels SMD=1.22,95%CI(0.86,1.58),P=0.000,decreased blood lipid TC levels SMD=-0.69,95%CI(-0.98,-0.39),P<0.00001,lowered blood lipid TG levels SMD=-0.75,95%CI(-1.09,-0.41),P<0.0001,improved renal function BUN levels SMD=-0.56,95%CI(-0.97,0.14),P=0.008 and Scr levels SMD=-0.58,95%CI(-0.89,-0.27),P=0.0002,reduced the incidence of adverse reactions OR=0.32,95%CI(0.22,0.44),P<0.00001.Egger and harbord test results suggest that some indicators have publication bias.ConclusionThe traditional Chinese medicine used is mainly jaundice,and the traditional Chinese medicine for replenishing qi and activating blood is used more frequently.In the basic application of hormone+immunosuppressive agents,Yiqihuoxue Chinese medicine has a good effect on MN,but it is limited to the quality of the included literature.The conclusion needs to be verified by more high-quality studies.
作者 高飞 王泽泽 杨冰 檀金川 GAO Fei;WANG Ze-ze;YANG Bing;TAN Jin-chuan(Hebei University of Chinese Medicine,Shijiazhuang 050200;TCM Hospital of Hebei Province,Shijiazhuang 050011,China)
出处 《海南医学院学报》 CAS 2020年第22期1705-1716,1728,共13页 Journal of Hainan Medical University
基金 国家中医药管理局肾病重点学科建设项目 河北省自然科学基金资助项目(H2019423037) 河北省中医药管理局资助项目(2018024)。
关键词 中药复方 激素 免疫抑制剂 膜性肾病 系统评价 META分析 Chinese herbal compound Hormone Immunosuppressant Membranous nephropathy Systematic review Meta-analysis
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