雷公藤多苷联合缬沙坦治疗慢性肾小球肾炎的系统评价和Meta分析

目的:系统评价雷公藤多苷联合缬沙坦治疗慢性肾小球肾炎的临床疗效及对24 h尿蛋白、血肌酐水平的影响。方法:检索雷公藤多苷联合缬沙坦治疗慢性肾小球肾炎的临床随机对照试验,根据文献纳入标准进行筛选,采用Cochrane系统评价手册5.1版对纳入的临床试验进行方法学质量评价,采用Cochrane协作网提供的软件Review Manager 5.3进行Meta分析。结果:共纳入6篇文献,共计533例患者。其中5篇文献质量较高,遵循随机、分配隐藏、单盲原则;1篇文献质量较差,随机分组方法具有高风险且未使用分配隐藏。Meta分析结果显示:雷公藤多苷联合缬沙坦治疗慢性肾小球肾炎的临床疗效优于单用缬沙坦治疗RR=1.24,95%CI(1.14,1.35),P0.001],且雷公藤多苷联合缬沙坦较单用缬沙坦治疗可更显著降低患者的24 h尿蛋白MD=-0.34,95%CI(-0.47,-0.21),P0.001]、血肌酐MD=-26.11,95%CI(-47.07,-5.15),P=0.01]水平。结论:雷公藤多苷联合缬沙坦治疗慢性肾小球肾炎较单用缬沙坦治疗具有更好的临床疗效,且可改善患者的24 h尿蛋白及血肌酐水平。

Tripterygium polyglycosides combined with valsartan in the treatment of chronic glomerulonephritis:A systematic review and Meta-analysis

  Objective: To systematically evaluate the clinical efficacy of tripterygium polyglycosides combined with valsartan in the treatment of chronic glomerulonephritis and the influence on the levels of 24 h urinary protein and serum creatinine.   Methods: The clinical randomized controlled trials of tripterygium polyglycosides combined with valsartan in the treatment of chronic glomerulonephritis were searched, and the literatures were filtered according to the inclusion criteria. The methodological quality of the clinical trials was evaluated by Cochrane System Evaluation Manual (version 5.1), and the Meta-analysis was carried out by Review Manager 5.3 provided by Cochrane.   Results: A total of 6 articles including 533 patients were included. Five articles were high quality studies following the principles of randomization, allocation concealment and single blind; one article was low quality study with high risk of randomized methods but without allocation concealment. The results of Meta-analysis showed that the clinical efficacy of tripterygium polyglycosides combined with valsartan in the treatment of chronic glomerulonephritis was superior to valsartan only , and tripterygium polyglycosides combined with valsartan showed better effects on decreasing the levels of 24 h urinary protein and serum creatinine compared with valsartan only.   Conclusion: Tripterygium polyglycosides combined with valsartan shows better clinical efficacy in the treatment of chronic glomerulonephritis compared with valsartan only, and can improve the levels of 24 h urinary protein and serum creatinine of the patients.