Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China.
Medicine (Baltimore). 2023 Mar 3;102(9):e32918. doi: 10.1097/MD.0000000000032918.
Idiopathic membranous nephropathy (IMN) is a noninflammatory autoimmune glomerulonephropathy. Based on the risk stratification for disease progression, conservative nonimmunosuppressive and immunosuppressive therapy strategies have been recommended. However, there remains challenges. Therefore, novel approaches to treat IMN are needed. We evaluated the efficacy of Astragalus membranaceus (A membranaceus) combined with supportive care or immunosuppressive therapy in the treatment of moderate-high risk IMN.
We comprehensively searched PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure, the Database for Chinese Technical Periodicals, Wanfang Knowledge Service Platform, and SinoMed. We then performed a systematic review and cumulative meta-analysis of all randomized controlled trials assessing the two therapy methods.
The meta-analysis included 50 studies involving 3423 participants. The effect of A membranaceus combined with supportive care or immunosuppressive therapy is better than that of supportive care or immunosuppressive therapy along in regulating for improving 24 hours urinary total protein (MD = -1.05, 95% CI [-1.21, -0.89], P = .000), serum albumin (MD = 3.75, 95% CI [3.01, 4.49], P = .000), serum creatinine (MD = -6.24, 95% CI [-9.85, -2.63], P = .0007), complete remission rate (RR = 1.63, 95% CI [1.46, 1.81], P = .000), partial remission rate (RR = 1.13, 95% CI [1.05, 1.20], P = .0004).
Adjunctive use of A membranaceus preparations combined with supportive care or immunosuppressive therapy have a promising treatment for improving complete response rate, partial response rate, serum albumin, and reducing proteinuria, serum creatinine levels compared to immunosuppressive therapy in people with MN being at moderate-high risk for disease progression. Given the inherent limitations of the included studies, future well-designed randomized controlled trials are required to confirm and update the findings of this analysis.
特发性膜性肾病（IMN）是一种非炎症性自身免疫性肾小球肾炎。基于疾病进展的风险分层，已推荐保守的非免疫抑制和免疫抑制治疗策略。然而，仍然存在挑战。因此，需要新的方法来治疗 IMN。我们评估了黄芪（A membranaceus）联合支持治疗或免疫抑制治疗在治疗中高危 IMN 中的疗效。
我们全面检索了 PubMed、Embase、Cochrane 图书馆、中国国家知识基础设施、中国技术期刊数据库、万方知识服务平台和 SinoMed。然后，我们对所有评估两种治疗方法的随机对照试验进行了系统评价和累积荟萃分析。
荟萃分析纳入了 50 项研究，共 3423 名参与者。黄芪联合支持治疗或免疫抑制治疗的效果优于单纯支持治疗或免疫抑制治疗，可改善 24 小时尿总蛋白（MD=-1.05，95%CI[-1.21，-0.89]，P=0.000）、血清白蛋白（MD=3.75，95%CI[3.01，4.49]，P=0.000）、血肌酐（MD=-6.24，95%CI[-9.85，-2.63]，P=0.0007）、完全缓解率（RR=1.63，95%CI[1.46，1.81]，P=0.000）和部分缓解率（RR=1.13，95%CI[1.05，1.20]，P=0.0004）。
与免疫抑制治疗相比，在中高危疾病进展风险的 MN 患者中，黄芪制剂联合支持治疗或免疫抑制治疗具有改善完全缓解率、部分缓解率、血清白蛋白和降低蛋白尿、血肌酐水平的有前途的治疗作用。鉴于纳入研究的固有局限性，需要进行未来精心设计的随机对照试验来证实和更新本分析的结果。
