滋阴清热法治疗狼疮性肾炎临床疗效的Meta分析  

Clinical Efficacy of Yin-nourishing and Heat-clearing Method for the Treatment of Lupus Nephritis:A Meta-analysis

作　　者：张紫嫣 张一凡 石秀杰 施月 张琪 柳菁 段行宇 赵明明[2] 张昱[2] ZHANG Zi-yan;ZHANG Yi-fan;SHI Xiu-jie;SHI Yue;ZHANG Qi;LIU Jing;DUAN Hang-yu;ZHAO Ming-ming;ZHANG Yu(Graduate School,Beijing University of Chinese Medicine,Beijing 100029;Department of Nephrology,Xiyuan Hospital,Chinese Academy of Chinese Medical Sciences,Beijing 100091)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]中国中医科学院西苑医院肾病科,北京100091

出　　处：《世界中西医结合杂志》2024年第12期2343-2352,共10页World Journal of Integrated Traditional and Western Medicine

基　　金：北京市自然科学基金面上项目(7232315);中国中医科学院科技创新工程重大攻关项目(CI2021A01206);中国中医科学院西苑医院学术经验继承项目(0203049)。

摘　　要：目的系统评价滋阴清热法联合西药治疗狼疮性肾炎(Lupus nephritis,LN)的有效性。方法系统检索中国知网、万方数据库、维普网、PubMed、Web of science、EMbase等数据库,检索时限从2005年1月1日至2024年1月31日,筛选发表的关于滋阴清热法治疗LN患者的临床随机对照试验(Randomized controlled trial,RCT),对照组采用西药常规治疗,治疗组在对照组基础上采用以滋阴清热法为主的中药组方或中成药治疗。采用Cochrane风险偏倚评估工具进行文献质量评价,应用RevMan 5.4和Stata 16.0软件完成全部统计分析。结果最终纳入17项随机对照试验,共计1150例LN患者。Meta分析结果显示,治疗组相较于对照组可提高临床总有效率[RR=1.20,95%CI(1.14,1.26),Z=6.96,P<0.00001];减轻狼疮活动,系统性红斑狼疮疾病活动指数评分(Systemic lupus erythematosus disease activity index,SLEDAI)[MD=-2.29,95%CI(-2.83,-1.75),Z=8.29,P<0.00001];降低24 h尿蛋白定量(24 hours urine protein,24 h PRO)[MD=-0.57,95%CI(-0.95,-0.19),Z=2.91,P=0.004]、血清肌酐(Serum creatinine,SCr)水平[MD=-9.67,95%CI(-12.23,-7.10),Z=7.38,P<0.00001]、血清尿素氮(Blood urea nitrogen,BUN)水平[MD=-0.95,95%CI(-1.29,-0.61),Z=5.51,P<0.00001]、免疫球蛋白G(Immunoglobulin g,IgG)水平[MD=-1.23,95%CI(-2.34,-0.12),Z=2.17,P=0.03]、红细胞血沉(Erythrocyte sedimentation rate,ESR)[MD=-6.52,95%CI(-9.70,-3.35),Z=4.03,P<0.0001]、C反应蛋白(C reactive protein,CRP)水平[MD=-3.52,95%CI(-4.21,-2.82),Z=9.92,P<0.00001],升高白蛋白(Albumin,ALB)水平[MD=3.70,95%CI(2.54,4.87),Z=6.23,P<0.00001]、补体C3(Complement C3,C3)水平[MD=0.13,95%CI(0.06,0.19),Z=3.98,P<0.0001]、补体C4(Complement C4,C4)水平[MD=0.04,95%CI(0.02,0.07),Z=3.22,P=0.001]。结论滋阴清热法治疗LN具有良好的疗效和一定的循证医学证据,值得临床进一步研究和推广。Objective To systematically evaluate the effectiveness of the yin-nourishing and heat-clearing method combined with Western medicine in the treatment of lupus nephritis(LN).Methods A systematic search was conducted in databases including CNKI,Wanfang Data,VIP,PubMed,Web of Science,and EMbase,covering the period from January 1,2005,to January 31,2024.Randomized controlled trials(RCTs)on the use of the yin-nourishing and heat-clearing method in the treatment of LN patients were selected.The control group received standard Western medicine treatment,while the treatment group received yin-nourishing and heat-clearing Chinese medicine formulas or Chinese patent medicines in addition to standard Western treatment.The Cochrane Risk of Bias Tool was used for quality assessment of the literature.Statistical analyses were performed using RevMan 5.4 and Stata 16.0 software.Results A total of 17 RCTs involving 1150 LN patients were included in the Meta-analysis.The results showed that the treatment group,compared to the control group,significantly improved the clinical total effective rate[RR=1.20,95%CI(1.14,1.26),Z=6.96,P<0.00001];reduced lupus activity as assessed by the Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)[MD=-2.29,95%CI(-2.83,-1.75),Z=8.29,P<0.00001];reduced 24-hour urine protein(24 h PRO)levels[MD=-0.57,95%CI(-0.95,-0.19),Z=2.91,P=0.004],serum creatinine(SCr)levels[MD=-9.67,95%CI(-12.23,-7.10),Z=7.38,P<0.00001],blood urea nitrogen(BUN)levels[MD=-0.95,95%CI(-1.29,-0.61),Z=5.51,P<0.00001],immunoglobulin G(IgG)levels[MD=-1.23,95%CI(-2.34,-0.12),Z=2.17,P=0.03],erythrocyte sedimentation rate(ESR)[MD=-6.52,95%CI(-9.70,-3.35),Z=4.03,P<0.0001],C-reactive protein(CRP)levels[MD=-3.52,95%CI(-4.21,-2.82),Z=9.92,P<0.00001];increased albumin(ALB)levels[MD=3.70,95%CI(2.54,4.87),Z=6.23,P<0.00001],complement C3(C3)levels[MD=0.13,95%CI(0.06,0.19),Z=3.98,P<0.0001],and complement C4(C4)levels[MD=0.04,95%CI(0.02,0.07),Z=3.22,P=0.001].Conclusion The yin-nourishing and heat-clearing method combined with Western medicine

关 键 词：滋阴清热法 狼疮性肾炎 中医药 随机对照试验 META分析 

分 类 号：R593.242[医药卫生—内科学]