摘要
目的系统评价益肾化湿颗粒联合ACEI/ARB血管紧张素Ⅱ受体阻滞剂(angiotensinⅡreceptor blocker,ARB)或血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)类药物治疗慢性肾炎的疗效及安全性,为临床应用提供循证医学证据。方法基于PubMed、Embase、Cochrane Library、CNKI、万方、维普、CBM等文献数据库检索有关益肾化湿颗粒联合ACEI/ARB类药物治疗慢性肾炎的随机对照试验(randomized controlled trial,RCT)或qRCT研究,进行筛选收录及质量评价。运用RewMAN 5.3软件进行Meta分析,比较联合益肾化湿颗粒用药的疗效差异及不良反应发生率。结果20篇文献,共2486例患者符合标准被纳入研究。Meta分析结果表明,与单纯以ACEI/ARB类药物为主的西医常规疗法相比,联合使用益肾化湿颗粒治疗后能显著降低患者的血肌酐[MD=-17.70,95%CI(-22.74,-12.66),P<0.01]、尿素氮[MD=-1.67,95%CI(-1.89,-1.46),P<0.01]、24 h尿蛋白定量[MD=-0.41,95%CI(-0.45,-0.36)],改善血浆白蛋白[MD=2.34,95%CI(0.88,3.80)],提高临床总有效率[OR=4.46,95%CI(3.45,5.76)],且没有增加患者不良反应风险。但在降低血尿方面,没有明显的效果[MD=-1.71,95%CI(-4.38,0.86),P=0.19]。结论联合使用益肾化湿颗粒能够提高ACEI/ARB类药物治疗慢性肾炎的临床治疗效果,改善患者的肾功能,但受限于研究体量,部分结局指标还需更多临床证据进一步验证。
Objective To systematically evaluate the efficacy and safety of Yishenhuashi Granule plus ACEI/ARB drug for chronic glomerulonephritis(CGN)and provide evidence-based references for clinical practices.Methods Randomized control trials(CTs)and quasi-randomized control trials(qRCTS)related to treating CGN with Yishenhuashi Granule plus ACEI/ARB drug were collected from the databases of PubMed,Embase,Cochrane Library,CNKI,WangFang,VIP and CBM.The quality of included studies was evaluated and RewMAN 5.3 utilized for data analysis.Results Twenty eligible studies of 2885 cases were finally included.Meta-analysis indicated that Yishenhuashi Granule plus ACEI/ARB drug could improve clinical efficacy of CGN[OR=4.46,95%CI(3.45,5.76)]through reducing serum creatinine(Scr)(MD=-17.70,95%CI(-22.74,-12.66),P<0.01),urinary nitrogen(BUN)(MD=-1.67,95%CI(-1.89,-1.46),P<0.01),urinary protein quantification(24hUTP)[MD=-0.41,95%CI(-0.45,-0.36)]and plasma albumin(Alb)[MD=2.34,95%CI(0.88,3.80)]without a greater incidence of adverse reactions.However,there was no obvious effect in lowering hematuria[MD=-1.71,95%CI(-4.38,0.86),P=0.19].Conclusions As compared with ACEI/ARB drug alone,Yishenhuashi Granule plus ACEI/ARB drug can improve overall effective rate and restore renal function.And more clinical proofs are required for further validation due to limited quantity/quality of included studies.
作者
赵青
郑敏
杨钰凤
吴屹莲
舒薇
Zhao Qing;Zhen Min;Yang Yu-feng;Wu Yi-lian;Shu Wei(Department of Pharmacy,Zhabei Central Hospital,Jing’an District,Shanghai 200040,China;Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)
出处
《临床肾脏病杂志》
2021年第11期895-903,共9页
Journal Of Clinical Nephrology
基金
上海市临床药学重点专科建设项目[沪卫药政〔2019〕1号-2]。
