中成药联合免疫抑制剂治疗特发性膜性肾病有效性及安全性的网状Meta分析OA

Objective:To conduct a network meta-analysis based on a frequentist framework to evaluate the efficacy and safety of Chinese patent medicines combined with immunosuppressive agents in the treatment of idiopathic membranous nephropathy(IMN).Methods:A comprehensive computer-based search was conducted to retrieve publicly published randomized controlled trials(RCTs)on Chinese patent medicines combined with immunosuppressive agents in the treatment of IMN.The following electronic databases were searched:CNKI,Wanfang Data,VIP,SinoMed,Web of Science,Embase,PubMed,and the Cochrane Library.Literature management was performed using NoteExpress 3.6 software.Two investigators independently screened the literature,extracted data,and assessed the quality of the included studies using the Cochrane Risk of Bias tool.Subsequently,a network meta-analysis was conducted using Stata 15.1 software.Results:A total of 29 two-arm RCTs involving 2,113 participants and 16 interventions were included.The surface under the cumulative ranking curve(SUCRA)analysis revealed the following rankings:In terms of clinical response rate,the combination of Huangkui Capsule(HK)+Cyclosporine A(CsA)+Hormone(H)ranked first(SUCRA:94.3%),followed by Tripterygium wilfordii polyglycoside(TW)+Mycophenolate mofetil(MMF)+H(SUCRA:86.8%),TW+Tacrolimus(TAC)+H(SUCRA:79.5%),and HK+TAC+H(SUCRA:65.7%).Regarding the reduction of 24-hour urinary total protein(24 h UTP),TW+TAC+H demonstrated the best performance(SUCRA:83.3%),followed by Zhengqing Fengtongning Tablet(ZQF)+H(SUCRA:81.8%),HK+TAC+H(SUCRA:80.0%),TW+H(SUCRA:77.4%),HK+Cyclophosphamide(CTX)+H(SUCRA:68.5%),and HK+CsA+H(SUCRA:66.8%).In terms of reducing serum creatinine(SCr),TW+TAC+H ranked first(SUCRA:93.5%),followed by TW+MMF+H(SUCRA:83.4%)and HK+CTX+H(SUCRA:81.8%).For elevating serum albumin(ALB),TW+H showed the best effect(SUCRA:98.7%),followed by ZQF+H(SUCRA:90.8%),HK+CsA+H(SUCRA:80.7%),TW+TAC+H(SUCRA:78.9%),and HK+TAC+H(SUCRA:68.0%).Regarding the incidence of adverse events,CTX+H carried the highest risk(SUCRA:91.6%),followed by HK+CTX+H(SUCRA:84.3%),TAC+H(SUCRA:67.0%),HK+TAC+H(SUCRA:62.3%),and TW+TAC+H(SUCRA:57.2%).Conclusion:The combination of HK+CsA+H emerged as the optimal combined therapeutic regimen.TW+MMF+H demonstrated comparable safety to the optimal regimen but with slightly lower efficacy.For patients with good tolerance,TW+TAC+H and HK+TAC+H may be considered as alternatives,as both regimens were associated with relatively higher risks of adverse events,yet their efficacy ranked only second to that of HK+CsA+H and TW+MMF+H.