益气活血法治疗特发性膜性肾病的Meta分析(1)
[摘要]特發性膜性肾病(IMN)的发病率越来越高，中医药治疗INM的临床研究也日益增多。该研究客观评价益气活血法治疗IMN的有效性和安全性。计算机检索了PubMed，EMbase，the Cochrane Library，中国生物医学文献数据库(CBM)，中国知网(CNKI)，万方(Wanfang)，维普(VIP)数据库。2名研究者单独筛选文献、提取资料，并用软件RevMan 53作Meta分析，用软件GRADEprofiler 36按照GRADE系统对Meta分析的结局指标进行证据分级。最终纳入11个研究，共725例IMN患者。Meta分析结果显示：运用益气活血法治疗IMN，降低患者的24 h UTP[RR=-123，95% CI=(-194，-053)，P=0000 6]，TC[RR=-039，95% CI=(-057，-020)，P<0000 1]、TG[RR=-049，95% CI=(-082，-015)，P=0004]及升高ALB[RR=356，95% CI=(164，547)，P=0000 3]的效果显著优于对照组，且安全性[RR=023，95% CI=(010，052)，P=0000 4]更高。但在改善Scr[RR=-325，95% CI=(-935，284)，P=030]和BUN[RR=-081，95% CI=(-229，066)，P=028]方面无显著性差异。并统计临床使用频次居前6位的中药，依次是黄芪、当归、川芎、党参、白术、丹参。目前证据提示临床中治疗IMN时，当注重中医之益气活血法的应用，同时重视黄芪、当归、川芎等中药的合理使用；由于主要结局指标24 h UTP的GRADE证据等级为极低质量，尚缺乏高质量证据证实益气活血法的临床疗效，仍需要更多设计严瑾、大样本的多中心随机对照试验进一步加以验证。
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[关键词]特发性膜性肾病； 益气活血法； 随机对照试验； Meta分析
Metaanalysis of Yiqi Huoxue method in treating idiopathic
membranous nephropathy
ZHENG Qiyan1， SUN Luying2*， JIN Huanan2， ZHOU Qian1， ZHANG Wen1， WANG Yahui1
(1. First School of Clinical Medicine， Beijing University of Chinese Medicine， Beijing 100029， China；
2. Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine， Beijing 100700， China)
, 百拇医药
[Abstract]The incidence of idiopathic membranous nephropathy (IMN) is increasing year by year， and the clinical research on Chinese medicine treatment of INM is also growing This study aims to evaluate the efficiency and safety of Yiqi Huoxue method for IMN Data sources used were from PubMed， EMbase， the Cochrane Library， CBM， CNKI， Wanfang and VIP database Two researchers independently screened the literature and extracted data RevMan 53 software was used for Meta analysis， and the evidences were graded for the outcomes according to GRADE system by using GRADEprofiler 36 Eventually， eleven trials (725 participants) were included in the Metaanalyses There was statistically significant difference between Yiqi Huoxue method and controls when combining all trials in 24 h UTP [RR=-123， 95%CI=(-194，-053)， P=0000 6] or when combining all trials in ALB [RR=356， 95%CI=(164， 547)， P=0000 3] Meanwhile， there was statistically significant difference between Yiqi Huoxue method and controls when combining all trials in TC [RR=-039， 95%CI=(-057， -020)， P<0000 1] or when combining all trials in TG [RR=-049， 95%CI=(-082， -015)， P=0004] However， there was no statistically significant difference between Yiqi Huoxue method and controls when combining all trials in Scr [RR=-325， 95%CI=(-935， 284)， P=030] or when combining all trials in BUN [RR=-081，95%CI=(-229， 066)， P=028] In the statistics， the most frequently used Chinese medicines in clinical application were Astragali Radix， Angelicae Sinensis Radix， Chuanxiong Rhizoma， Codonopsis Radix， Atractylodis Macrocephalae Rhizome and Salvia Miltiorrhiza The present evidences suggested that Yiqi Huoxue method should be thought highly of in the treatment of IMN， and at the same time， the rational use of traditional Chinese medicine， such as Astragali Radix， Angelicae Sinensis Radix， Chuanxiong Rhizoma also should be paid attention to However， due to the GRADE evidence grading of the primary outcome measure of 24 h UTP had very low quality， this review can not provide highquality evidence to prove the clinical efficacy of this method More welldesigned and largescale multicenter randomized controlled trials should be conducted in the future for verification., 百拇医药(郑启艳孙鲁英 金化男周倩 张雯王娅辉)
, http://www.100md.com
[关键词]特发性膜性肾病； 益气活血法； 随机对照试验； Meta分析
Metaanalysis of Yiqi Huoxue method in treating idiopathic
membranous nephropathy
ZHENG Qiyan1， SUN Luying2*， JIN Huanan2， ZHOU Qian1， ZHANG Wen1， WANG Yahui1
(1. First School of Clinical Medicine， Beijing University of Chinese Medicine， Beijing 100029， China；
2. Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine， Beijing 100700， China)
, 百拇医药
[Abstract]The incidence of idiopathic membranous nephropathy (IMN) is increasing year by year， and the clinical research on Chinese medicine treatment of INM is also growing This study aims to evaluate the efficiency and safety of Yiqi Huoxue method for IMN Data sources used were from PubMed， EMbase， the Cochrane Library， CBM， CNKI， Wanfang and VIP database Two researchers independently screened the literature and extracted data RevMan 53 software was used for Meta analysis， and the evidences were graded for the outcomes according to GRADE system by using GRADEprofiler 36 Eventually， eleven trials (725 participants) were included in the Metaanalyses There was statistically significant difference between Yiqi Huoxue method and controls when combining all trials in 24 h UTP [RR=-123， 95%CI=(-194，-053)， P=0000 6] or when combining all trials in ALB [RR=356， 95%CI=(164， 547)， P=0000 3] Meanwhile， there was statistically significant difference between Yiqi Huoxue method and controls when combining all trials in TC [RR=-039， 95%CI=(-057， -020)， P<0000 1] or when combining all trials in TG [RR=-049， 95%CI=(-082， -015)， P=0004] However， there was no statistically significant difference between Yiqi Huoxue method and controls when combining all trials in Scr [RR=-325， 95%CI=(-935， 284)， P=030] or when combining all trials in BUN [RR=-081，95%CI=(-229， 066)， P=028] In the statistics， the most frequently used Chinese medicines in clinical application were Astragali Radix， Angelicae Sinensis Radix， Chuanxiong Rhizoma， Codonopsis Radix， Atractylodis Macrocephalae Rhizome and Salvia Miltiorrhiza The present evidences suggested that Yiqi Huoxue method should be thought highly of in the treatment of IMN， and at the same time， the rational use of traditional Chinese medicine， such as Astragali Radix， Angelicae Sinensis Radix， Chuanxiong Rhizoma also should be paid attention to However， due to the GRADE evidence grading of the primary outcome measure of 24 h UTP had very low quality， this review can not provide highquality evidence to prove the clinical efficacy of this method More welldesigned and largescale multicenter randomized controlled trials should be conducted in the future for verification., 百拇医药(郑启艳孙鲁英 金化男周倩 张雯王娅辉)