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目的:用Meta分析方法评价中西医结合治疗中国成年人特发性膜性肾病(IMN)的疗效,为中西医结合治疗中国成年人IMN提供科学依据。方法:计算机检索Pub Med、CBM、VIP、CNKI、万方等全文数据库,检索范围均从建库至2014年10月31日,筛选(1)中西医结合治疗组1(中药复方+CTX+Pred)治疗IMN的随机对照临床实验(RCT),(2)中西医结合治疗组2(中药复方+ACEI和/或ARB)治疗IMN的RCT,用Review Manager 5.2(Rev Man 5.2)软件进行统计分析。结果:最终选出符合条件的12篇文献,包括698例IMN患者,其中试验组358例,对照组340例。Meta分析结果显示:(1)全部患者总体分析结果:1完全缓解率:中西医结合治疗组与单纯西药组相比,(OR=2.90,95%CI 2.04~4.13),Z=5.94,P<0.000 01。2总有效率:(OR=3.61,95%CI 2.47~5.30),Z=6.58,P<0.000 01。3不良反应率:(OR=0.26,95%CI 0.15~0.44),Z=4.90,P<0.000 01。(2)中西医结合治疗组1与CTX+Pred相比,完全缓解率(OR=2.52,95%CI 1.68~3.79),Z=4.46,P<0.000 01。总有效率(OR=4.13,95%CI 2.53~6.74),Z=5.66,P<0.000 01。(3)中西医结合治疗组2与ACEI和/或ARB相比,完全缓解率(OR=4.33,95%CI 2.12~8.82),Z=4.03,P<0.000 1。总有效率(OR=2.92,95%CI 1.58~5.39),Z=3.42,P=0.000 6。结论:中西医结合疗法治疗IMN可提高临床疗效,改善预后。
OBJECTIVE: To evaluate the efficacy of integrated traditional Chinese and western medicine in the treatment of idiopathic membranous nephropathy (IMN) in Chinese adults by Meta-analysis, and provide a scientific basis for the treatment of Chinese adults with IMN by combining traditional Chinese and western medicine. Methods: The full-text databases of Pub Med, CBM, VIP, CNKI and Wanfang were searched by computer. The search scope ranged from building database to October 31, 2014. Screening (1) Integrative Medicine Group 1 (TCM Compound + CTX + Pred ) Randomized controlled clinical trial (RCT) for treatment of IMN, (2) RCT of IMN treated with Integrative Medicine Group 2 (TCM Compound + ACEI and / or ARB) and statistical analysis with Review Manager 5.2 (Rev Man 5.2) software. RESULTS: Twelve eligible articles were finally selected, including 698 patients with IMN, of whom 358 were in the experimental group and 340 in the control group. Meta analysis showed that: (1) The overall analysis results of all patients: 1 Complete remission rate: Compared with western medicine group (OR = 2.90,95% CI 2.04-4.13), Z = 5.94, P < 0.000 01.2 The total effective rate: (OR = 3.61, 95% CI 2.47 ~ 5.30), Z = 6.58, P <0.000 01.3 Adverse reaction rate: (OR = 0.26, 95% CI 0.15 ~ 0.44) 4.90, P <0.000 01. (2) Compared with CTX + Pred, the complete remission rate (OR = 2.52, 95% CI 1.68-3.79), Z = 4.46, P <0.000 01. The total effective rate (OR = 4.13, 95% CI 2.53 ~ 6.74), Z = 5.66, P <0.000 01. (3) The complete remission rate (OR = 4.33, 95% CI 2.12 ~ 8.82), Z = 4.03, P <0.0001 in Integrative Medicine group 2 compared with ACEI and / or ARB. The total effective rate (OR = 2.92, 95% CI 1.58 ~ 5.39), Z = 3.42, P = 0.0006. Conclusion: Integrative Chinese and Western medicine treatment of IMN can improve clinical efficacy and improve prognosis.