益气养阴法联合西药治疗肾病综合征的疗效及安全性的Meta分析  

Meta-analysis of Efficacy and Safety of Therapy of Replenishing Qi and Nourishing Yin Combined with Western Medicine in Treating Nephrotic Syndrome

作　　者：李康健 李坤豪 邓喜艳 钟宇媚 梁兆雄 黄清明 杨京华[1,2] 许楷斯 林季文[1,2] LI Kang-Jian;LI Kun-Hao;DENG Xi-Yan;ZHONG Yu-Mei;LIANG Zhao-Xiong;HUANG Qing-Ming;YANG Jing-Hua;XU Kai-Si;LIN Ji-Wen(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120 Guangdong,China;WEN Zi-Yuan’s Academic Inheritance Studio of Lingnan Pediatric School,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120 Guangdong,China;Medical College of Shaoguan University,Shaoguan 512005 Guangdong,China)

机构地区：[1]广州中医药大学第二附属医院,广东广州510120 [2]广东省中医院文子源儿科学术流派传承工作室,广东广州510120 [3]韶关学院医学院,广东韶关512005

出　　处：《广州中医药大学学报》2024年第2期509-519,共11页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医院岭南儿科文子源学术流派传承工作室建设项目(编号:E43613)。

摘　　要：【目的】系统评价益气养阴法联合西药治疗肾病综合征的有效性及安全性。【方法】检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方(Wangfang)、维普(VIP)、PubMed、Web of Science、Cochrane Library、Embase等国内外主要文献数据库,筛选其中有关益气养阴法联合西药(试验组)对比单纯西药(对照组)治疗肾病综合征的临床随机对照试验(RCTs),采用Cochrane手册中的偏倚风险工具进行文献的质量评价,运用RevMan 5.3软件进行Meta分析。【结果】共纳入18个RCTs,包含1334例患者。Meta分析结果显示,益气养阴法联合西药在提高临床有效率(RR=1.24,95%CI[1.16,1.32],P<0.00001),改善24 h尿蛋白定量(24hUPRO)(MD=-0.92,95%CI[-1.09,-0.75],P<0.00001)、血清白蛋白(ALB)(MD=7.06,95%CI[4.73,9.39],P<0.00001)、尿素氮(BUN)(MD=-1.57,95%CI[-2.01,-1.13],P<0.00001)、血肌酐(SCr)(MD=-12.23,95%CI[-16.58,-7.88],P<0.00001)、总胆固醇(TC)(MD=-1.06,95%CI[-1.69,-0.43],P=0.0009)、甘油三酯(TG)(MD=-0.58,95%CI[-0.94,-0.21],P=0.002)水平,以及降低不良反应发生率(RR=0.50,95%CI[0.40,0.64],P<0.00001)方面优于单纯西药治疗。【结论】益气养阴法联合西药治疗肾病综合征在提高临床疗效及改善24hUPRO、ALB、BUN、SCr、TC、TG方面优于单纯西药治疗,且能降低激素产生的不良反应。因纳入文献较少,文献质量较低,潜在疗效需更多的高质量研究进行验证。Objective To systematically evaluate the clinical efficacy and safety of therapy of replenishing qi and nourishing yin combined with western medicine for the treatment of nephrotic syndrome.Methods The primary domestic and oversea literature databases such as CNKI,CBM,Wangfang Data,VIP,PubMed,Web of Science,Cochrane Library,and Embase were retrieved.The clinical randomized controlled clinical trials(RCTs)using therapy of replenishing qi and nourishing yin combined with western medicine(shortened as combined therapy)versus western medicine alone in treating nephrotic syndrome was screened out,and the meta-analysis was performed with RevMan 5.3 software.Results A total of 18 RCTs met the inclusion criteria,including 1334 patients.The results of meta-analysis showed that the combined therapy had superiority in enhancing clinical effective rate(RR=1.24,95%CI[1.16,1.32],P<0.00001),improving 24-hour urine protein(24hUPRO)(MD=-0.92,95%CI[-1.09,-0.75],P<0.00001),serum albumin(ALB)(MD=7.06,95%CI[4.73,9.39],P<0.00001),blood urea nitrogen(BUN)(MD=-1.57,95%CI[-2.01,-1.13],P<0.00001),serum creatinine(SCr)(MD=-12.23,95%CI[-16.58,-7.88],P<0.00001),total cholesterol(TC)(MD=-1.06,95%CI[-1.69,-0.43],P=0.0009)and triglyceride(TG)(MD=-0.58,95%CI[-0.94,-0.21],P=0.002)levels,and decreasing the incidence of adverse reactions(RR=0.50,95%CI[0.40,0.64],P<0.00001)as compared with western medicine alone.Conclusion The results indicated that therapy of replenishing qi and nourishing yin combined with western medicine is more effective on enhancing clinical efficacy for the treatment of nephrotic syndrome,improving 24hUPRO,ALB,BUN,SCr,TC and TG,and decreasing hormone-induced adverse reaction than western medicine alone.However,for the small-size of sample and the low quality of the included literature,the conclusion needs to be carefully considered and still needs to be verified by more highquality randomized controlled trials.

关 键 词：益气养阴法 肾病综合征 有效率 24 h尿蛋白定量 血清白蛋白 尿素氮 血肌酐 总胆固醇 甘油三酯 安全性 META分析 

分 类 号：R256.5[医药卫生—中医内科学]