中成药治疗特发性膜性肾病的网状Meta分析

Network Meta-analysis of Chinese patent medicines in treatment of idiopathic membranous nephropathy

系统评价不同中成药治疗特发性膜性肾病的疗效及安全性。计算机检索PubMed、EMbase、Cochrane Library、中国知网(CNKI)、中国生物医学文献服务系统(SinoMed)、万方(Wanfang)、维普(VIP),搜集中成药治疗特发性膜性肾病的随机对照试验(RCT),检索时限为建库至2022年12月。采用Cochrane偏倚风险评价工具评估纳入文献的质量,应用Stata 15.0、GEMTC软件进行贝叶斯网状Meta分析。最终纳入51项RCTs,涉及9种中成药,3 591例患者。网状Meta分析结果显示,在总有效率和提高血浆白蛋白方面,排序前3的干预措施为正清风痛宁缓释片+常规西药、百令胶囊+常规西药、雷公藤多苷片+常规西药;在降低24 h尿蛋白定量方面,排序前3的干预措施为正清风痛宁缓释片+常规西药、肾复康胶囊+常规西药、黄葵胶囊+常规西药;在降低血肌酐方面,排序前3的干预措施为肾复康胶囊+常规西药、百令胶囊+常规西药、正清风痛宁缓释片+常规西药;在安全性方面,中成药联合常规西药的不良反应整体少于对照组。结果提示,中成药联合常规西药可提高特发性膜性肾病的疗效,且安全性好,在临床中可根据患者具体症状进行差异化用药。但今后仍需要开展多中心、大样本、高质量的RCT进一步验证。

This study aimed to systematically evaluate the efficacy and safety of different Chinese patent medicines in the treatment of idiopathic membranous nephropathy.The relevant randomized controlled trial(RCT) was retrieved from PubMed,EMbase,Cochrane Library,CNKI,SinoMed,Wanfang,and VIP with the time interval from database inception to December 2022.The Cochrane risk of bias assessment tool was employed to evaluate the quality of the included RCT,and Stata 15.0 and GEMTC to perform the Bayesian network Meta-analysis.Finally,51 RCTs were included,involving 9 Chinese patent medicines and 3 591 patients.The results of network Meta-analysis showed that in terms of the total effective rate and the increase in plasma albumin,the top three interventions were Zhengqing Fengtongning Sustained Release Tablets + conventional western medicine,Bailing Capsules + conventional western medicine,and Tripterygium Glycosides Tablets + conventional western medicine.In terms of reducing 24-hour urine total protein,the top three interventions were Zhengqing Fengtongning Sustained Release Tablets + conventional western medicine,Shenfukang Capsules +conventional western medicine,and Huangkui Capsules + conventional western medicine.In terms of reducing serum creatinine,the top three interventions were Shenfukang Capsules + conventional western medicine,Bailing Capsules + conventional western medicine,and Zhengqing Fengtongning Sustained Release Tablets + conventional western medicine.In terms of safety,Chinese patent medicines combined with conventional western medicine had fewer adverse reactions than the control group.The results suggest that Chinese patent medicines combined with conventional western medicine can improve the therapeutic effect on idiopathic membranous nephropathy,and differentiated medications can be adopted according to the specific symptoms of patients in clinical treatment.Further validation needs to be carried out in the future with multi-center,large-sample,and high-quality RCT.