黄芪（Astragalus membranaceus，AM），是个常用的中药，黄芪被广泛用于治疗肾病综合症。肾病综合症的特征包括液体过载、外周水肿和蛋白尿等症状，是一种复杂的肾脏疾病。本研究评估了黄芪的免疫调节功能、在肾小球病理中的作用机制，以及含有黄芪的中药方剂与西药治疗相比的疗效和安全性。本研究的总结为：

1. 作用机制：黄芪的可能通过以下几种机制发挥其作用：

1. 1. 免疫调节：黄芪调节免疫反应，可能通过减少炎症，增强保肾。
   2. 抗炎作用：黄芪能影响与炎症相关的关键细胞因子，如IL-1、IL-6、IL-8和TNF-α，从而减缓炎症对肾脏造成的损伤。
   3. 保护肾脏：黄芪能减少蛋白尿和高脂血症以显示它的保肾功能。

• 临床研究证据：对比含黄芪的中药方剂与标准西药治疗的随机对照试验（RCT）的综合评估得出以下结论：

1. 生化改善：黄芪补充剂与生化标志物显著改善相关，包括蛋白尿的减少、高脂血症的减轻和血清白蛋白水平的升高。
2. 肾功能：将黄芪添加到标准西药治疗中通常能保持或改善肾功能。
3. 缓解率：接受含黄芪中药方剂的患者比单独接受标准西药治疗的患者表现出更高的缓解率。
4. 炎症标志物：黄芪治疗组相比仅接受类固醇治疗的组，炎症细胞因子（IL-1、IL-6、IL-8、TNF-α）显著减少。
5. 复发率降低：一些研究表明，接受黄芪治疗的患者复发率低于对照组。
6. 安全性：黄芪通常耐受良好，与标准西药治疗相比，副作用或不良事件的发生没有显著差异。研究中使用的剂量范围为每日9到30克，符合《中国药典》的推荐范围。

关于黄芪与免疫抑制药物之间潜在相互作用的担忧已有注意。体外研究结果不一，且中药方剂的复杂性（通常包含多种草药）增加了隔离特定相互作用的挑战。然而，监测环孢素和他克莫司等免疫抑制药物的药物水平，有助于管理药物暴露潜在问题。

总之，现有证据支持黄芪作为原发性肾病综合症管理的辅助治疗。尽管所评审的RCT的Jadad评分普遍较低，表明需要进行更高质量的研究，但一致的积极结果表明，黄芪可能在不显著增加不良反应的情况下，改善缓解率和疾病标志物。需要进一步的严格研究，以更好地理解黄芪在肾病综合症管理中的长期效果和最佳使用方法。

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