Astragalus Membranaceus Herbal Formula for the Treatment of Idiopathic Membranous Nephropathy with Nephrotic Syndrome: A Systematic Review and Meta-Analysis

The consequence of our meta-analysis shown that there was no significantly statistical difference in affecting total remission rate (RR: 1.02, 95% CI: 0.87 to 1.20, I2= 76%), levels of 24-hour urine protein excretion (24hUP) (MD: -0.50, 95% CI: -1.10 to 0.10, I2= 78%) and serum albumin (Alb) (MD: 0.45, 95% CI: -1.01 to 1.91, I2= 0%) between Astragalus membranaceus (AM) herbal formula and routine treatment (RT). However, AM herbal formula plus RT had more advantages in reducing total recurrence rate (RR = 0.33, 95% CI:0.18 to 0.61, I2= 0%), levels of 24hUP (MD: -0.77, 95% CI: -0.93 to -0.60, I2= 0%), total cholesterol (TC) (MD: -0.79, 95% CI: -1.09 to -0.48, I2= 45%), triglyceride (TG) (MD: -0.26, 95% CI: -0.39 to -0.14, I2= 52%) and increasing total remission rate (RR: 1.30, 95% CI: 1.16 to 1.46, I2= 0%) and Alb (MD: 1.87, 95% CI: 1.01 to 2.72, I2= 0%) levels than RT alone. In addition, when compared with RT alone, AM herbal formula used alone or plus RT had no significantly statistical difference in changing levels of serum creatinine (Scr) (MD: -1.05, 95% CI: -3.73 to 1.62, I2= 0%), blood urea nitrogen (BUN) (MD: -0.11, 95% CI: -0.34 to 0.12, I2= 0%), alanine aminotransferase (ALT) (MD: 0.15, 95% CI: -0.73 to 1.04, I2= 0%), aspartate aminotransferase (AST) (MD: -0.43, 95% CI: -1.39 to 0.54, I2= 9%) and fasting blood glucose (Glu) (MD: 0.00, 95% CI: -0.11 to 0.12, I2= 0%). Last but not least, AM herbal formula used alone or plus RT had a lower rate of total adverse events (RR: 0.51, 95% CI: 0.37 to 0.68, I2= 0%) than RT alone.本荟萃分析结果显示，黄芪（Astragalus membranaceus）方剂与常规治疗（routine treatment, RT）相比，在总缓解率（相对风险（Relative Risk, RR）=1.02，95%置信区间（Confidence Interval, CI）：0.87~1.20，异质性指数I²=76%）、24小时尿蛋白定量（24-hour urine protein excretion, 24hUP，均数差（Mean Difference, MD）=-0.50，95%CI：-1.10~0.10，I²=78%）及血清白蛋白（Alb，MD=0.45，95%CI：-1.01~1.91，I²=0%）方面的差异均无统计学显著性。然而，黄芪方剂联合常规治疗相较于单纯常规治疗，在降低总复发率（RR=0.33，95%CI：0.18~0.61，I²=0%）、24hUP水平（MD=-0.77，95%CI：-0.93~-0.60，I²=0%）、总胆固醇（total cholesterol, TC，MD=-0.79，95%CI：-1.09~-0.48，I²=45%）、甘油三酯（triglyceride, TG，MD=-0.26，95%CI：-0.39~-0.14，I²=52%），以及提升总缓解率（RR=1.30，95%CI：1.16~1.46，I²=0%）与血清白蛋白水平（MD=1.87，95%CI：1.01~2.72，I²=0%）上均更具优势。此外，与单纯常规治疗相比，单用黄芪方剂或黄芪方剂联合常规治疗对血清肌酐（serum creatinine, Scr，MD=-1.05，95%CI：-3.73~1.62，I²=0%）、血尿素氮（blood urea nitrogen, BUN，MD=-0.11，95%CI：-0.34~0.12，I²=0%）、丙氨酸氨基转移酶（alanine aminotransferase, ALT，MD=0.15，95%CI：-0.73~1.04，I²=0%）、天冬氨酸氨基转移酶（aspartate aminotransferase, AST，MD=-0.43，95%CI：-1.39~0.54，I²=9%）及空腹血糖（fasting blood glucose, Glu，MD=0.00，95%CI：-0.11~0.12，I²=0%）水平的影响均无统计学显著性差异。最后，单用黄芪方剂或黄芪方剂联合常规治疗的总不良事件发生率均低于单纯常规治疗（RR=0.51，95%CI：0.37~0.68，I²=0%）。