摘要
目的系统评价雷公藤多苷联合糖皮质激素治疗成年人原发性肾病综合征(PNS)的有效性及安全性。方法计算机检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普网、万方数据知识服务平台、Cochrane Library、Pub Med、科学引文索引(SCI)数据库,手工检索有关中医、中西医结合和肾脏疾病相关杂志,检索时间为建库/创刊至2016年3月。纳入试验组干预措施为雷公藤多苷联合糖皮质激素,对照组单用足量糖皮质激素的随机对照试验。使用Stata 12.0软件对总缓解率、不良反应发生率进行Meta分析。结果共纳入18篇文献,包括1 236例患者,其中对照组620例,试验组616例。Meta分析结果显示,试验组总缓解率高于对照组[RR=1.21,95%CI(1.11,1.32),P<0.001]。亚组分析结果显示,雷公藤多苷联合中等剂量糖皮质激素总缓解率高于对照组[RR=1.11,95%CI(1.02,1.20),P=0.015];雷公藤多苷联合足量糖皮质激素总缓解率高于对照组[RR=1.31,95%CI(1.22,1.41),P<0.001]。试验组不良反应发生率低于对照组[RR=0.51,95%CI(0.37,0.70),P<0.001]。总缓解率漏斗图不对称,提示存在发表偏倚。结论雷公藤多苷联合糖皮质激素较单纯使用糖皮质激素治疗PNS可提高总缓解率,减少不良反应发生率,有望成为一种有前景的治疗方案,但纳入文献的方法学质量不高,需更多高质量研究进一步证实。
Objective To systematically evaluate the efficacy and safety of Tripterygium glycosides combined withglucocorticoid in the treatment of primary nephrotic syndrome （PNS） in adults. Methods We dida review of randomized controlled trials of Tripterygium glycosides combined with glucocorticoid versus full dose of glucocorticoid alone forPNS in adults as of March 2016 from CBM , CNKI , VIP , Wanfang data , Cochrane Library , Puperiodicals （traditional Chinese medicine , integrated traditional Chinese and western medicine and kidney disease）. Manalysis of the overall response rate （ORR） and incidence of adverse reactions was performed by using stata 12. 0. Results A total of 18 articles with 1 236 patients （620 in the control group and 616 in the experimental group） in all were included. Meta - analysis showed that compared with control group , experimental group had higher ORR [ RR = 1. 21 , 95% Cl （ 1. 11 , 1. 3 2 ） , P 〈0. 001〕, and lower incidence of adverse reactions [ RR = 0. 51 , 95% Cl （0. 37 , 0. 70） , P 〈 0. 001〕 . Subgroup analysis demonstrated that , the ORR of Tripterygium glycosides combined with medium dose of glucocorticoid wadose of glucocorticoid alone [ RR = 1.11 , 95% Cl （1 .0 2 , 1 .2 0 ） , P = 0 . 0 1 5〕, and the ORR of Tri pterygium glycosidescombined with full dose of glucocorticoid was higher than that of full dose of glucocorticoid alone [ RR = 1.31 , 95% Cl （ 1. 22 , 1.41）, P 〈 0. 001〕. Asymmetric funnel plot of the ORR demonstrated publication bias. Conclusion For PNS in adults ,Tripterygium glycosides combined with glucocorticoid is a promising treatment for it has higher efficacy and lower incidence ofadverse reactions than full dose of glucocorticoid alone. However , this needs to be further confsince the methodological quality of the included articles in this study is not high.
出处
《中国全科医学》
CAS
北大核心
2017年第14期1742-1748,共7页
Chinese General Practice
基金
广东省教育部产学研结合项目(2011B090400570)
广州市科技计划项目(2015Y2000007)
广东高校血液净化技术与设备工程技术研究中心(GCZX-A1104)
关键词
肾病综合征
雷公藤
泼尼松
META分析
Nephrotic syndrome
Tripterygium wilfordii glucocorticoid
Meta-analysis
