摘要
目的：系统评价雷公藤治疗小儿紫癜性肾炎的疗效及安全性。方法：通过检索The Cochrane Library、Pub Med、EMBASE、CBM、CNKI、VIP和Wan Fang Data,纳入雷公藤治疗小儿紫癜性肾炎的RCT研究,检索时限为建库至2015年4月9日,语言不限。2位研究者按纳入与排除标准筛选文献、提取资料,并对文献进行质量评价,采用Rev Man 5.2软件进行Meta分析。结果：共纳入16个RCT,总人数1086。结果显示：（1）完全缓解率：雷公藤联用糖皮质激素优于单用激素（RR1.29,95%CI 1.11～1.49,P=0.000 7）;CTX联用激素优于雷公藤联用激素（RR0.35,95%CI 0.16～0.75,P=0.007）。（2）总缓解率：将血尿、蛋白尿与基线值相比下降50%作为缓解基准时,在常规治疗基础上用或不用雷公藤治疗未见统计学差异（RR1.21,95%CI 0.74～1.98,P=0.45）,而当将血尿、蛋白尿与其基线值相比下降30%作为基准时,见统计学差异（RR1.26,95%CI 1.04～1.51,P=0.02）;雷公藤联用激素较单用激素组有优势（RR 1.25,95%CI 1.16～1.34,P〈0.000 01）;CTX联用激素优于雷公藤联用激素（RR 0.68,95%CI 0.47～0.99,P=0.04）。（3）复发率：雷公藤联用激素较单用激素组能降低疾病复发率（RR0.18,95%CI 0.05～0.69,P=0.01）。（4）不良反应：①肝功能损害发生率：单用雷公藤未见肝损（RR 3.27,95%CI 0.16～66.82,P=0.44）;联用激素后出现了肝损（RR 3.39,95%CI 1.31～8.74,P=0.01）。②血白细胞下降发生率：单用雷公藤未见血白细胞下降（RR 3.93,95%CI 0.45～34.49,P=0.22）;联用激素后却反见血白细胞下降（RR 7.49,95%CI 2.03～27.62,P=0.003）;雷公藤或CTX联用激素均未见血白细胞下降（RR 1.12,95%CI0.08～16.52,P=0.94）。结论：雷公藤可在一定程度上缓解紫癜性肾炎的血尿、蛋白尿,联用糖皮质激素能协同紫癜性肾炎的疗效且可降低疾病复发。就肝功能损害及血白细胞下降等不良反应而言,雷公藤总体安全。
Objective： To systematically review the efficacy and safety of tripterygium in treatment of children with HSPN. Methods： All randomized controlled trials（ RCTs） of tripterygium for the treatment of children with HSPN were collected from the Cochrane Library,Pub Med,EMBASE,CBM,CNKI,VIP and Wan Fang Data without language limitation. Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed methodological quality of included studies. Meta-analysis was then conducted using Rev Man 5. 2 software. Results： A total of 16 RCTs involving 1086 patients were included. The result of Meta-analysis：（ 1） Complete Remission：The combination of tripterygium and GC was more effective than GC group [RR 1. 29,95% CI（ 1. 11 ～ 1. 49）,P =0. 000 7],but less effective than the combination of CTX and GC [RR 0. 35,95% CI（ 0. 16 ～ 0. 75）,P = 0. 007].（ 2）Total Remission： Tripterygium didn＇t show advantage when taking hematuria and proteinuria declined more than 50% of the baseline as criteria [RR 1. 21,95% CI（ 0. 74 ～ 1. 98）,P = 0. 45]. However,tripterygium did show advantage when taking hematuria and proteinuria declined more than 30% of the baseline as criteria [RR 1. 26,95% CI（ 1. 04 ～ 1. 51）,P = 0. 02]. The combination of tripterygium and GC was more effective than GC group [RR 1. 25,95% CI（ 1. 16 ～1. 34）,P〈0. 00001],but less effective than the combination of CTX and GC[RR 0. 68,95% CI（ 0. 47 ～ 0. 99）,P = 0.04].（ 3） Relapse： The combination of tripterygium and GC had lower risk of relapse than GC group [RR 0. 18,95% CI（ 0. 05 ～ 0. 69）,P = 0. 01].（ 4） Side Effects： 1On the basis of routine treatment,tripterygium showed no signi cant difference in liver injury [RR 3. 27,95% CI（ 0. 16 ～ 66. 82）,P = 0. 44]but the combination of tripterygium and GC had an increase in liver injury compared to GC group [RR 3. 39,95% CI（ 1. 31 ～ 8. 74）,P = 0. 01]. 2Tripterygium showed no signi cant diffe
出处
《中华中医药学刊》
CAS
北大核心
2016年第6期1497-1503,I0015,共8页
Chinese Archives of Traditional Chinese Medicine
关键词
雷公藤
紫癜性肾炎
META分析
tripterygium
Henoch-Schonlein purpura nephritis
Meta-analysis
