Meta Analysis Of Idiopathic Membrane Nephropathy In Adults

Objective:The meta-analysis of clinical studies on TCM in treating adult idiopathic membrane nephropathy was conducted to evaluate the efficacy and safety of TCM and provide evidence-based medical basis for the treatment of patients with idiopathic membrane nephropathy.Method:The randomized controlled experiment on the treatment of idiopathic membranous nephropathy in adults in CNKI,Wanfang,VIP,CBM,Pubmed and The Cochrane Library was searched by computer search.The search period was set as:from the date of database establishment to December 31,2021.The retrieved literature was imported into Note Express3.5.0 literature management software,excluding duplicate literature,two researchers according to the inclusion and exclusion criteria,then established Excel table to extract the literature data,evaluated the literature quality using Cochrane collaboration risk bias evaluation criteria,and conducted Meta analysis of the included data in the literature by using Revman5.4 software.Results:In this study,24 articles were finally included,including 1669 patients,including841 in the treatment group and 828 in the control group.Meta-analysis Results:(1)Total clinical effectiveness of western medicine: a total of 19 articles were included,RR=1.30,95%CI=[1.22,1.38],P<0.00001<0.05,which was statistically significant difference,so it is believed that traditional Chinese medicine and western medicine treatment is significantly better than pure western medicine treatment in improving the overall clinical efficiency of western medicine.(2)TCM syndrome efficacy,TCM syndrome score: 12 articles reported the efficacy of TCM syndrome,RR=1.44,95%CI=[1.32,1.57],P<0.00001.<0.05,which was statistically significant difference,suggesting that the efficacy of TCM syndrome in the experimental group was better than that in the control group.Fifteen articles reported the status of TCM syndrome integration,MD=-4.81,95%CI=[-6.11,-3.51],P<0.00001<0.05,which was statistically significant difference,the experimental group were lower than those in the control group.It is considered that traditional Chinese medicine combined with western medicine treatment is significantly better than pure western medicine treatment in improving the syndrome of traditional Chinese medicine.(3)24-hour urinary protein quantification: 22 articles reported the quantification of urinary protein at 24 h,MD=-0.96,95%CI=[-1.21,-0.70],P<0.00001<0.05,which was statistically significant difference,suggesting that western medicine combination was significantly superior to western medicine alone in reducing 24-hour urinary protein quantification in patients with IMN.(4)Serum albumin,total cholesterol,triglycerides: 22 articles reported on serum albumin,MD=3.42,95%CI=[2.72,4.11],P<0.00001<0.05,which was statistically significant difference.17 articles reported on total cholesterol,MD=-0.74,95%CI=[-0.98,-0.50],P<0.00001<0.05,which was statistically significant difference.15 articles reported in triglycerides,MD=-0.39,95%CI=[-0.52,-0.25],P<0.00001<0.05,which was statistically significant difference.The analysis showed that Chinese medicine combination was significantly better than Western medicine alone in raising serum albumin and reducing its total cholesterol and triglycerides in patients with IMN.(5)Blood creatinine,urea nitrogen,AST,ALT:11 articles reported blood creatinine after treatment,MD=-2.79,95%CI=[-6.03,0.45],P=0.09>0.05,which was no significant difference.7 articles reported on blood urea nitrogen after treatment,MD=-0.19,95%CI=[-0.42,0.45],P=0.12>0.05,which was no statistically significant difference.5 articles have reported on the AST after treatment,MD=-0.12,95%CI=[-1.14,0.91],P=0.82>0.05,which was no significant difference.6 articles has reported the status of ALT after treatment,MD=0.62,95%CI=[-0.34,1.58],P=0.20>0.05,which was no statistically significant difference.Note that traditional Chinese medicine combined with western medicine treatment of adult idiopathic membranous nephropathy creatinine,urea nitrogen,AST,ALT efficacy compared with simple western medicine treatment,no obvious statistical difference,but sensitivity analysis found that the study can reduce the IMN patients with blood creatinine,urea nitrogen,ALT results have poor stability and reliability,the conclusion is not convincing.(6)Serum anti-PLA2 R antibody: 9 articles have reported the serum anti-PLA2 R antibodies,MD=-17.51,95%CI=[-30.09,-4.93],P=0.006<0.05,which was statistically significant difference,suggesting that TCM treatment combined with western medicine treatment was significantly superior to the control group in reducing serum anti-PLA2 R antibody.(7)Incidence of adverse reactions: 13 articles were included,RR=0.39,95%CI=[0.30,0.52],P<0.00001<0.05,which was statistically significant difference.It indicates that the incidence of adverse reactions combined with western medicine is lower than the western medicine treatment alone.At the same time,the subgroup analysis showed that TCM had a significant inhibitory effect on reducing infection,digestive tract symptoms,abnormal liver function,and leukopenia events.However,TCM did not seem to reduce the occurrence of blood glucose elevation events compared with the western medicine treatment group alone.Conclusion:(1)The treatment of traditional Chinese medicine and western medicine is significantly better than western medicine treatment alone in improving the total clinical efficiency of western medicine,improving TCM syndrome,increasing serum albumin,reducing urinary protein quantification for 24 h,total cholesterol,triglyceride,and serum anti-PLA2 R.(2)There is no significant difference between TCM and western medicine treatment compared with TCM treatment alone in reducing blood creatinine,BUN,ALT and AST,but the conclusion on the first three indicators lack reliability,and further research needs to study and confirm.(3)The incidence of adverse reactions between Chinese medicine and western medicine is lower than with western medicine alone.