摘要
目的:基于网状Meta分析对治疗高血压肾病(hypertensive nephropathy,HTN)的不同种类口服中成药的有效性及安全性进行评价。方法:计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、EMbase、Cochrane Library、Web of Science数据库,搜索建库至2024年3月20日所发表的治疗HTN中成药的随机对照试验(randomized controlled trials,RCT),采用RoB2、Stata 18.0软件进行数据统计分析。结果:最终纳入60篇RCTs,涉及11种中成药,总样本量5 576例。网状Meta分析结果显示:(1)在降低24 h尿蛋白定量(24 h UTP)方面,累计概率排名曲线下面积(SUCRA)排名前3的干预措施为金水宝胶囊/片+西医常规、松龄血脉康胶囊+西医常规、黄葵胶囊+西医常规;(2)在降低尿微量白蛋白(mALB)方面,SUCRA排名前3的干预措施为黄葵胶囊+西医常规、六味地黄丸+西医常规、通心络胶囊+西医常规;(3)在辅助降低收缩压(SBP)方面,SUCRA排名前3的干预措施为六味地黄丸+西医常规、百令胶囊+西医常规、黄芪片/颗粒+西医常规;(4)在辅助降低舒张压(DBP)方面,SUCRA排名前3的干预措施为黄芪片/颗粒+西医常规、六味地黄丸+西医常规、松龄血脉康胶囊+西医常规;(5)在降低血肌酐(Scr)方面,SUCRA排名前3的干预措施为复方丹参滴丸+西医常规、冠心丹参滴丸+西医常规、六味地黄丸+西医常规;(6)在降低尿素氮(BUN)方面,SUCRA排名前3的干预措施为复方丹参滴丸+西医常规、冠心丹参滴丸+西医常规、六味地黄丸+西医常规;(7)在降低胱抑素-C(Cys-C)方面,SUCRA排名前3的干预措施为黄葵胶囊+西医常规、冠心丹参滴丸+西医常规、百令胶囊+西医常规;(8)在提高内生肌酐清除率(Ccr)方面,SUCRA排名前3的干预措施为复方丹参滴丸+西医常规、冠心丹参滴丸+西医常规、金水宝胶囊/片+西医常规;(9)中成药的加用与不良反应的发生情况并无显著相关性。结论:在常规西医治疗的基础上,加用中成药治疗HTN有效且各有优势,能有效降低24 h UTP、mALB、Scr、BUN、Cys-C,辅助降低SBP、DBP,提高Ccr。但鉴于研究存在一定的局限性,上述结果尚需开展更多高质量临床RCTs予以验证。
Objective:To evaluate the efficacy and safety of different Chinese patent medicines in the treatment of hypertensive nephropathy(HTN)based on a network meta-analysis.Methods:The randomized controlled trials(RCTs)of Chinese patent medicines in the treatment of HTN were retrieved from CNKI,Wanfang,VIP,SinoMed,PubMed,EMbase,Cochrane Library,and Web of Science,from inception to March 20,2024.RoB2 and Stata 18.0 were used for data analysis.Results:A total of 60 RCTs were included,involving 11 Chinese patent medicines and 5576 patients.The results of the network meta-analysis based on the surface under the cumulative ranking curve(SUCRA)are summarized as follows.①In terms of reducing 24 h urine total protein(UTP),the top three interventions were Jinshuibao(金水宝)Capsules/Tablets+conventional Western medicine,Songling Xuemaikang(松龄血脉康)Capsules+conventional Western medicine,and Huangkui(黄葵)Capsules+conventional Western medicine.②In terms of reducing urine micro-albumin(mALB),the top three interventions were Huangkui Capsules+conventional Western medicine,Liuwei Dihuang(六味地黄)Pills+conventional Western medicine,and Tongxinluo(通心络)Capsules+conventional Western medicine.③In terms of assisting in reducing systolic blood pressure(SBP),the top three interventions were Liuwei Dihuang Pills+conventional Western medicine,Bailing(百令)Capsules+conventional Western medicine,and Huangqi(黄芪)Tablets/Granules+conventional Western medicine.①In terms of assisting in reducing diastolic blood pressure(DBP),the top three interventions were Huangqi Tablets/Granules+conventional Western medicine,Liuwei Dihuang Pills+conventional Western medicine,and Songling Xuemaikang Capsules+conventional western medicine.In terms of reducing serum creatine(Scr),the top three interventions were Compound Danshen(丹参)Dripping Pills+conventional Western medicine,Guanxin Danshen(冠心丹参)Dripping Pills+conventional Western medicine,and Liuwei Dihuang Pills+conventional western medicine.@In terms of reducing blood urea nitrogen(BUN),the top three interventions were Compound Danshen Dripping Pills+conventional Western medicine,Guanxin Danshen Dripping Pills+conventional Western medicine,and Liuwei Dihuang Pills+conventional Western medicine.ln terms of reducing cystatin-C(Cys-C),the top three interventions were Huangkui Capsules+conventional Western medicine,Guanxin Danshen Dripping Pills+conventional Western medicine,and Bailing Capsules+conventional Western medicine.In terms of improving the endogenous creatinine clearance rate(Ccr),the top three interventions were Compound Danshen Dripping Pills+conventional Western medicine,Guanxin Danshen Dripping Pills+conventional Western medicine,and Jinshuibao Capsules/Tablets+conventional Western medicine.There was no significant correlation between the addition of Chinese patent medicines and the incidence of adverse reactions.Conclusion:On the basis of conventional Western medicine treatment,the addition of Chinese patent medicines is effective and has its own advantages in the treatment of HTN,since it can effectively reduce 24-h UTP,mALB,Scr,BUN,and Cys-C,assist in lowering SBP and DBP,and improve the Ccr.However,due to the limitations of available studies,the above results remain to be verified by more high-quality RCTs.
作者
赵悦州
吕静
张春辉
杨冠琦
庞立健
孙昊
邹吉宇
洪健峰
马占泽
ZHAO Yuezhou;LV Jing;ZHANG Chunhui;YANG Guanqi;PANG Lijian;SUN Hao;ZOU Jiyu;HONG Jianfeng;MA Zhanze(Liaoning University of Traditional Chinese Medicine,Shenyang 110847;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032;Xichang Medical College,Xichang 615013)
出处
《中药药理与临床》
北大核心
2025年第7期71-83,120,共14页
Pharmacology and Clinics of Chinese Materia Medica
基金
国家自然科学基金项目(编号:81673956)
辽宁省科技计划联合基金项目(编号:2023-MSLH-175)
辽宁省“兴辽英才计划”项目(编号:XLYC2005006)。
关键词
中成药
高血压肾病
网状Meta分析
24
h尿蛋白
尿微量白蛋白
尿素氮
肌酐
胱抑素-C
Chinese patent medicine
Hypertensive nephropathy
Network meta-analysis
24-Hour urine total protein(24-h UTP)
Urine micro-albumin
Blood urea nitrogen(BUN)
Serum creatine(Scr)
Cystatin-C(Cys-C)
