雷公藤治疗特发性膜性肾病的Meta分析

Meta-analysis of Therapeutic Effect of Tripterygium Wilfordii Hook for Idiopathic Membranous Nephropathy

【目的】系统评价雷公藤治疗特发性膜性肾病(idiopathic membranous nephropathy,IMN)的有效性及安全性。【方法】通过系统检索中国生物医学数据库(CBM)、中国知网(CNKI),维普(VIP),万方(Wanfang)等中文数据库及The Cochrane Central Register of Controlled Trials(CENTRAL)、PubMed、Embase等英文数据库,收集雷公藤联合常规西医疗法或免疫抑制药物治疗特发性膜性肾病的随机对照试验。按纳入与排除标准筛选文献提取资料并评价纳入研究的偏倚风险后,采用RevMan软件进行Meta分析。【结果】共纳入10个研究,涉及761名患者。常规西医疗法基础上联合雷公藤在提高总有效率(RR=1.55,95%CI[1.08,2.25],Z=2.35,P=0.02)、降低24h尿蛋白定量(SMD=-0.41,95%CI[-0.70,-0.11],Z=2.71,P=0.007)方面优于常规西医疗法。免疫抑制药物基础上联合雷公藤在提高完全缓解率(RR=1.80,95%CI[1.47,2.19],Z=5.72,P<0.000 01)和总有效率(RR=1.33,95%CI[1.12,1.57],Z=3.30,P=0.001)以及降低24 h尿蛋白定量(SMD=-0.73,95%CI[-1.02,-0.44],Z=4.93,P<0.000 01)方面优于单纯免疫抑制药物。雷公藤联合常规西医疗法或免疫抑制药物治疗特发性膜性肾病的不良反应主要集中在肝功能损害、胃肠道反应、月经紊乱、血糖升高及增加感染风险等方面。【结论】雷公藤联合常规西医疗法或免疫抑制药物治疗特发性膜性肾病在减少24 h尿蛋白定量、提高总有效率与完全缓解率的方面显示一定优势,但因纳入研究的证据级别较低,结论尚需高质量的大样本的前瞻性随机对照试验进一步证实。

Objective To systematically evaluate the efficacy and safety of Tripterygium wilfordii Hook(TW)in treating idiopathic membranous nephropathy.Methods Computer retrieval was carried out in the Chinese medical databases of CBM,CNKI,VIP and Wanfang and in the English medical databases of the Cochrane Central Register of Controlled Trials(CENTRAL),PubMed and Embase for collecting the randomized controlled trials(RCTs)of TW combined with conventional western medicine or immunosuppressive drugs for the treatment of idiopathic membranous nephropathy.The literature was screened and the data was extracted according to the inclusion and exclusion criteria,the assessment of risk of bias was undergone,and then the Meta-analysis was performed by using RevMan software.Results A total of 10 RCTs involving 761 patients were included in the study.TW combined with conventional western medicine exerted statistical differences in increasing overall response rate(RR=1.55,95%CI[1.08,2.25],Z=2.35,P=0.02)and reducing 24-hour urinary protein(SMD=-0.41,95%CI[-0.70,-0.11],Z=2.71,P=0.007)in the patients with idiopathic membranous nephropathy as compared with the conventional western medicine alone;TW combined with immunosuppressive drugs showed statistical differences in increasing complete remission rate(RR=1.80,95%CI[1.47,2.19],Z=5.72,P<0.000 01)and overall response rate(RR=1.33,95%CI[1.12,1.57],Z=3.30,P=0.001),and in reducing 24-hour urinary protein(SMD=-0.73,95%CI[-1.02,-0.44],Z=4.93,P<0.000 01)as compared with the immunosuppressive drugs alone.In clinic,the adverse reaction of TW combined with conventional western medicine or immunosuppressive drugs for the treatment of idiopathic membranous nephropathy mainly manifested as liver function damage,gastrointestinal reaction,irregular menstruation,increased blood glucose,and risk of increased infection.Conclusion TW combined with conventional western medicine or immunosuppressive drugs exerts certain advantages of reducing 24-hour urinary protein and increasing overall response rate and complete remission rate for the treatment of idiopathic membranous nephropathy.However,for the inferiority of the included studies,the conclusion still needs high-quality and large-sample prospective randomized controlled trials to verify.