中药复方辅助治疗膜性肾病的系统评价和Meta分析

Systematic evaluation and Meta analysis of Chinese herbal compound adjuvant treatment of membranous nephropathy

[目的]系统评价在常规治疗的基础上加用中药复方治疗膜性肾病(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,收集中药复方辅助治疗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 5.3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、当归、山药、白术和党参。补虚药和活血化瘀药使用最多。在常规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=3.62,95%CI(2.43,5.41),P<0.000 01],改善中医证候积分[SMD=1.42,95%CI(1.17,1.68),P<0.000 01],降低24 h尿蛋白水平[SMD=-1.09,95%CI(-1.53,-0.66),P<0.000 01],提高血浆白蛋白水平[SMD=1.08,95%CI(0.57,1.60),P<0.000 01],降低TC水平[SMD=-0.35,95%CI(-0.67,-0.04),P=0.008]和TG水平[MD=-0.79,95%CI(-0.95,-0.63),P<0.000 01],但在改善肾功能(BUN、Scr)、提高中医证候疗效和减少不良反应方面作用不明显。倒漏斗图提示存在发表偏倚。[结论]所用中药以黄芪为主,补脾益肾中药使用频数较高。以补脾益肾为主的中药复方辅助治疗MN效果较好,但由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 in the treatment of membranous nephropathy(MN). [Methods] Computer searched China National Knowledge Infrastructure,Wanfang Database,Weipu Database,China Biomedical Database,PubMed Database,Embase Database,Cochrane Database collected clinical research of Chinese medicine compound adjuvant therapy MN,deleted duplicate literature,and removed the non-conformity and exclusion criteria by reading the title,abstract and full text. Data were extracted from the included literature and Meta-analysis was performed using RevMan software.[Results] The top 6 Chinese medicines were astragalus membranaceus,poria cocos,angelica sinensis,dioscoreae rhizoma,atractylodes macrocephala and codonopsis pilosula. Tonic drugs and blood-activating drugs were the most commonly used. The use of traditional Chinese medicine in the treatment of MN patients based on basic treatment can improve clinical efficacy[OR=3.62,95%CI(2.43,5.41),P<0.000 01],improve TCM syndrome scores[SMD=1.42,95%CI(1.17,1.68),P<0.000 01],reduce 24-hour urine protein levels [SMD=-1.09,95%CI(-1.53,-0.66),P<0.000 01],increased plasma albumin levels [SMD=1.08,95%CI(0.57,1.60),P<0.000 01],decreased blood lipids(TC) [SMD=-0.35,95%CI(-0.67,-0.04),P=0.008]and TG[MD=-0.79,95%CI(-0.95,-0.63),P<0.000 01],had no significant effect on improving renal function(BUN,Scr),TCM symptom efficacy and adverse reactions. Inverted funnel chart suggest that some indicators have publication bias. [Conclusion] The traditional Chinese medicine used is mainly angelica sinensis,and the traditional Chinese medicine for tonifying spleen and kidney is used more frequently. The traditional Chinese medicine compound supplemented by spleen and kidney is better in the treatment of MN,but it is limited to the quality of the literature. The conclusion needs to be verified by more high-quality studies.