世界中医药

目的:IgA肾病是以系膜区IgA沉积为主要特征的原发性肾小球疾病,异常IgA1的免疫复合物沉积及RAAS系统激活与其发病关系密切。目前主要使用ACEI或ARB类药物及糖皮质激素或联合免疫抑制剂治疗。近年来中医药在IgA肾病的防治中发挥了巨大的作用,其中祛风除湿法治疗IgA肾病成为关注的焦点,在西医治疗基础上联用祛风除湿的中药在提高临床疗效、减少蛋白尿、减轻血尿、保护肾功能方面效果显著,同时也可减轻激素及免疫抑制剂所产生的不良反应,逐渐被临床认可。但由于目前现有的研究样本量小,文献质量较低,很难被广泛接受,迫切需要科学的研究方法为临床提供充分的证据支持,所以本研究拟通过Meta分析,综合分析祛风除湿法治疗IgA肾病的临床疗效及安全性评估。方法:检索中文数据库包括中国知网、万方、维普及英文数据库包括PubMed、Cochrane Library及手工检索相关领域期刊杂志中关于祛风除湿法治疗风湿内扰型IgA肾病的随机对照试验。采用Cochrane协助网提供的RevMan 5.3软件进行Meta分析,主要研究指标为有效率、24 h尿蛋白定量、血肌酐、血清白蛋白、肾小球滤过率、中医证候积分评估及不良反应发生率。结果:通过计算机检索中英文数据库及手工检索中医肾病相关领域期刊杂志,共检索出197篇文献,然后逐一阅读题目及摘要、泛读及精读全文后排除主题不相关文献,排除回顾性研究、假随机、半随机、重复文献、会议论文、不符合纳入标准文献,最后纳入8篇随机对照试验,共826例患者进行研究。Meta分析结果显示在西医治疗基础上联合祛风除湿的方药比单纯西医治疗在提高临床疗效(OR=3.35,95%CI［2.20,5.10］,P<0.000 01)、降低24 h尿蛋白定量(MD=-0.46,95%CI［-0.76,-0.17］,P=0.002)、提高白蛋白(MD=4.95,95%CI［3.62,6.28］,P<0.000 01),减少不良反应发生率方面(OR=0.42,95%CI［0.22,0.80］,P=0.008)效果显著,差异均有统计学意义。而血肌酐(MD=-4.82,95%CI［-12.27,2.63］,P=0.20)、肾小球滤过率(MD=-0.63,95%CI［-4.26,2.99］,P=0.73)、中医证候积分方面(MD=-1.96,95%CI［-3.98,0.05］,P=0.06)差异均无统计学意义。结论:在西医基础上联合祛风除湿的方药治疗IgA肾病比单纯西医治疗,在提高临床有效率、降低蛋白尿、提高白蛋白、减少不良反应的发生方面效果显著,差异均有统计学意义。但此次纳入文献样本量小,文献质量均不高,未来需要更科学可靠的循证医学方法进一步完善祛风除湿法治疗IgA肾病的临床研究。

English Summary:

IgA nephropathy is a primary glomerular disease characterized by IgA deposition in the mesangial area. Abnormal IgA1 immune complex deposition and RAAS system activation are closely related to its pathogenesis. Currently, ACEI or ARB drugs and glucocorticoids or combined immunosuppressive agents are mainly used for treatment. In recent years, traditional Chinese medicine (TCM) has played a important role in the prevention and treatment of IgA nephropathy. Among them, the treatment of IgA nephropathy by the method of dispelling wind and removing dampness has become the focus of attention. On the basis of Western medicine treatment, the combination of medicine for removing wind and dampness has improved clinical efficacy, and it has significant effects on reducing proteinuria, hematuria and protecting kidney function. Meanwhile it can also reduce the side effects caused by hormones and immunosuppressants, and has gradually been clinically recognized. However, due to the small sample size of the existing research and the low quality of the literature, it is difficult to be widely accepted, and there is an urgent need for scientific research methods to provide sufficient evidence for clinical support. Therefore, this study intends to conduct clinical efficacy and safety of comprehensive analysis of the method of dispelling wind and removing dampness in the treatment of IgA nephropathy through Meta analysis. Methods:Chinese databases including CNKI, Wanfang, and Uyghur English databases including PubMed, Cochrane Library was searched, and randomized controlled trials on expelling wind and removing dampness in the treatment of rheumatic internal disturbance IgA nephropathy was hand-searched. Meta analysis was performed using RevMan 5.3 software provided by Cochrane.com. The main research indicators were effective rate, 24-hour urine protein quantification, serum creatinine, serum albumin, glomerular filtration rate, TCM syndrome score evaluation, and incidence of adverse reactions. Results:A total of 197 papers were retrieved through computer search of Chinese and English databases and manual searches of journals and magazines related to TCM nephropathy. Then, after reading the topics and abstracts, extensive reading and intensive reading of the full text, subjects irrelevant to the literature were excluded. Retrospective studies, false randomized, semi-randomized, repeated literature, conference papers did not meet the inclusion criteria, and finally 8 randomized controlled trials with a total of 826 patients for research was included. Meta-analysis results showed that the combination of Western medicine treatment and the formula of dispelling wind and removing dampness can improve the clinical efficacy (OR=3.35, 95%CI ［2.20,5.10］, P<0.000 01) and decrease the 24 h urine protein quantitative (MD=-0.46,95%CI ［-0.76,-0.17］, P=0.002), increase albumin (MD=4.95,95%CI［3.62,6.28］, P<0.000 01), reduce the incidence of adverse reactions (OR=0.42,95%CI［0.22,0.80］, P=0.008). The effect was significant, and the differences were statistically significant. And blood creatinine (MD=-4.82, 95%CI ［-12.27,2.63］, P=0.20), glomerular filtration rate (MD=-0.63, 95%CI［-4.26,2.99］, P=0.73), TCM syndrome scores (MD=-1.96, 95%CI［-3.98,0.05］, P=0.06) were not statistically significant. Conclusion:On the basis of Western medicine, the treatment of IgA nephropathy combined with the prescription of dispelling wind and removing dampness is more effective in improving the clinical effectiveness, reducing proteinuria, increasing albumin, and reducing the occurrence of adverse reactions. The differences are statistically significant. However, the sample size of the literature included this time is small, and the quality of the literature is not high. In the future, more scientific and reliable evidence-based medicine methods are needed to further improve the clinical research on the treatment of IgA nephropathy with the method of removing wind and removing dampness.

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