Efficacy and Safety of Tripterygium Wilfordii Hook F for IgA Nephropathy: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIWen-wen ¹ , LIUXiao-li ¹ , WUHao ² , SUJun-xia ² ,  LIJian-hua ²

1. First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;
2. Department of Nephropathy, First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

LIJian-hua, Email: ldyylijianhua@163.com

Keywords：

Tripterygium wilfordii Hook F; IgA nephropathy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150036

Video：

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Objective To systematically review the efficacy and safety of tripterygium wilfordii Hook F (TwHF) in treatment of IgA nephropathy. Methods The Cochrane Library (Issue 4, 2014), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched up to April 28th, 2004 to collect randomized controlled trials (RCTs) about the efficacy and safety of TwHF in treatment of IgA nephropathy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Metaanalysis was then conducted using RevMan 5.2 software. Results A total of 10 RCTs involving 521 patients were finally included. The results of meta-analysis showed that:a) compared with MMF group, TwHF group had better outcomes in complete remission (CR) (OR=2.01, 95%CI 1.04 to 3.87, P=0.04), total remission (TR) (OR=3.17, 95%CI 1.22 to 8.23, P=0.02), 24-hour urinary protein content (MD=2.61, 95%CI 1.34 to 3.88, P<0.000 1), and level of serum albumin (MD=-6.42, 95%CI -9.13 to -3.71, P<0.000 01); and b) compared with ACEI (ARB) group, TwHF group had better outcomes in complete remission (CR) (OR=4.25, 95%CI 2.63 to 6.86, P<0.000 01), total remission (TR) (OR=4.15, 95%CI 2.33 to 7.40, P<0.000 01), 24-hour urinary protein content (MD=1.15, 95%CI 0.63 to 1.66, P<0.000 1), and level of serum albumin (MD=-5.18, 95%CI -8.96 to -1.41, P=0.007), all with significant differences. Conclusion TwHF has favourable therapeutic efficacy and safety in treatment of IgA nephropathy. Due to limited quantity and quality of the included studies, the above conclusion should be verified by further conducting more high quality, large-scale, multicentre RCTs.

Citation： LIWen-wen, LIUXiao-li, WUHao, SUJun-xia, LIJian-hua. Efficacy and Safety of Tripterygium Wilfordii Hook F for IgA Nephropathy: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(2): 206-214. doi: 10.7507/1672-2531.20150036 Copy

1.	Chen YZ, Gao Q, Zhao XZ, et al. Meta-Analysis of Tripterygium Wilfordii Hook F in the Immunosuppressive Treatment of IgA Nephropathy. J Intern Med, 2010, 49(19):2049-2055.
2.	Barratt J, Feehally J. IgA nephropathy. JASN, 2005, 16(7):2088-2097.
3.	Tumlin JA, Madaio MP, Hennigar R. Idiopathic IgA nephropathy:pathogenesis, histopathology, and therapeutic options. Clin J Am Soc Nephrol, 2007, 2(5):1054-1061.
4.	Samuels JA, Strippoli GF, Craig JC, et al. Immunosuppressive agents for treating IgA nephropathy. Cochrane Database Syst Rev, 2003, 4:CD003965.
5.	Nolin L, Courteau M. Management of IgA nephropathy:evidencebased recommendations. Kidney Int, 1999, 55:S56-S62.
6.	梅其炳, 刘莉. 作用于免疫系统的药物. 杨世杰, 主编. 药理学. 第2版. 北京:人民卫生出版社, 2010:497.
7.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. Ann Intern Med, 2009, 151(4):264-269.
8.	陈耀龙, 蔡羽嘉, 王梦书, 等. 循证医学术语介绍Ⅱ. 中国循证医学杂志, 2009, 9(2):143-146.
9.	吴泰相, 商洪才, 卞兆祥. 随机对照实况试验的概念, 设计和实施. 中国循证医学杂志, 2009, 9(12):1277-1280.
10.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:http://www.cochrane.org/handbook.
11.	陈耀龙, 李晓, 梅又文, 等. 循证医学术语介绍V. 中国循证医学杂志, 2009, 9(7):734-739.
12.	王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10):1115-1118.
13.	沈水娟, 胡作祥, 王时敏, 等. 雷公藤多苷片联合苯那普利治疗IgA肾病的疗效观察. 中国中西医结合肾病杂志, 2009, 10(2):154-155.
14.	陈英, 覃英. 三联疗法治疗中等量蛋白尿IgA肾病临床疗效观察. 现代医药卫生, 2009, 25(11):1645-1646.
15.	沈良儒, 张丽丽, 池本香, 等. 双倍剂量的雷公藤多苷在IgA肾病治疗中的疗效观察. 右江医学, 2011, 39(2):142-144.
16.	陈喜生. 吗替麦考酚酯联合雷公藤多甙治疗IgA肾病的临床疗效观察. 医学临床研究, 2011, 28(7):1295-1296.
17.	周学华, 姚春阳. 雷公藤多苷治疗IgA肾病30例的临床研究. 药物与临床, 2010, 48(30):34-35.
18.	谢彤, 钟应雄, 麦伟民, 等. 雷公藤多苷治疗IgA肾病的临床研究. 中国医师进修杂志, 2008, 31(1):35-36.
19.	张慧儒. 雷公藤多苷联合吗替麦考酚酯治疗老年IgA肾病的疗效观察. 中国医药导报, 2013, 10(1):81-82.
20.	杨福燕, 魏崇一, 李超英. 雷公藤多甙治疗非肾病综合征IgA肾病对照研究. 中华全科医学, 2008, 6(11):1138-1139.
21.	李艳玲. 雷公藤多苷联合吗替麦考酚酯治疗IgA肾病的临床研究. 中国医药科学, 2012, 2(8):62-103.
22.	曹珊, 陈清萍. 雷公藤多苷片联合缬沙坦治疗IgA肾病蛋白尿的疗效. 实用临床医学, 2012, 13(11):9-10.
23.	Donadio JV, Grande JP. IgA nephropathy. N Engl J Med, 2002, 347(10):738-748.
24.	韦慧琴, 李良. IgA肾病的发病机制及治疗研究进展. 内科, 2011, 6(3):252-254.
25.	李建秋, 朱彩凤, 俞东容. 雷公藤制剂治疗IgA肾病的现状及展望. 浙江中医药大学学报, 2008, 32(4):556-558.
26.	沈世忠, 杨忠民, 胡义阳, 等. 雷公藤多苷对IgA肾病CD4+ CD25 high调节性T细胞及Th1、Th2影响. 中国中西医结合肾病杂志, 2013, 14(11):979-982.
27.	杜晓刚, 甘华. PDGF在肾脏疾病中的研究进展. 医学综述, 2001, (1):39.
28.	张雯, 程军, 陶筱娟, 等. 雷公藤多甙对IgA肾病小鼠肾皮质PDGF-B及受体表达的影响. 中国中医药科技, 2008, 15(5):347-348.
29.	张鑫. 雷公藤制剂毒副作用及减毒方法研究进展. 中国药学杂志, 2013, 48(22):1897-1901.

1. Chen YZ, Gao Q, Zhao XZ, et al. Meta-Analysis of Tripterygium Wilfordii Hook F in the Immunosuppressive Treatment of IgA Nephropathy. J Intern Med, 2010, 49(19):2049-2055.
2. Barratt J, Feehally J. IgA nephropathy. JASN, 2005, 16(7):2088-2097.
3. Tumlin JA, Madaio MP, Hennigar R. Idiopathic IgA nephropathy:pathogenesis, histopathology, and therapeutic options. Clin J Am Soc Nephrol, 2007, 2(5):1054-1061.
4. Samuels JA, Strippoli GF, Craig JC, et al. Immunosuppressive agents for treating IgA nephropathy. Cochrane Database Syst Rev, 2003, 4:CD003965.
5. Nolin L, Courteau M. Management of IgA nephropathy:evidencebased recommendations. Kidney Int, 1999, 55:S56-S62.
6. 梅其炳, 刘莉. 作用于免疫系统的药物. 杨世杰, 主编. 药理学. 第2版. 北京:人民卫生出版社, 2010:497.
7. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. Ann Intern Med, 2009, 151(4):264-269.
8. 陈耀龙, 蔡羽嘉, 王梦书, 等. 循证医学术语介绍Ⅱ. 中国循证医学杂志, 2009, 9(2):143-146.
9. 吴泰相, 商洪才, 卞兆祥. 随机对照实况试验的概念, 设计和实施. 中国循证医学杂志, 2009, 9(12):1277-1280.
10. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:http://www.cochrane.org/handbook.
11. 陈耀龙, 李晓, 梅又文, 等. 循证医学术语介绍V. 中国循证医学杂志, 2009, 9(7):734-739.
12. 王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10):1115-1118.
13. 沈水娟, 胡作祥, 王时敏, 等. 雷公藤多苷片联合苯那普利治疗IgA肾病的疗效观察. 中国中西医结合肾病杂志, 2009, 10(2):154-155.
14. 陈英, 覃英. 三联疗法治疗中等量蛋白尿IgA肾病临床疗效观察. 现代医药卫生, 2009, 25(11):1645-1646.
15. 沈良儒, 张丽丽, 池本香, 等. 双倍剂量的雷公藤多苷在IgA肾病治疗中的疗效观察. 右江医学, 2011, 39(2):142-144.
16. 陈喜生. 吗替麦考酚酯联合雷公藤多甙治疗IgA肾病的临床疗效观察. 医学临床研究, 2011, 28(7):1295-1296.
17. 周学华, 姚春阳. 雷公藤多苷治疗IgA肾病30例的临床研究. 药物与临床, 2010, 48(30):34-35.
18. 谢彤, 钟应雄, 麦伟民, 等. 雷公藤多苷治疗IgA肾病的临床研究. 中国医师进修杂志, 2008, 31(1):35-36.
19. 张慧儒. 雷公藤多苷联合吗替麦考酚酯治疗老年IgA肾病的疗效观察. 中国医药导报, 2013, 10(1):81-82.
20. 杨福燕, 魏崇一, 李超英. 雷公藤多甙治疗非肾病综合征IgA肾病对照研究. 中华全科医学, 2008, 6(11):1138-1139.
21. 李艳玲. 雷公藤多苷联合吗替麦考酚酯治疗IgA肾病的临床研究. 中国医药科学, 2012, 2(8):62-103.
22. 曹珊, 陈清萍. 雷公藤多苷片联合缬沙坦治疗IgA肾病蛋白尿的疗效. 实用临床医学, 2012, 13(11):9-10.
23. Donadio JV, Grande JP. IgA nephropathy. N Engl J Med, 2002, 347(10):738-748.
24. 韦慧琴, 李良. IgA肾病的发病机制及治疗研究进展. 内科, 2011, 6(3):252-254.
25. 李建秋, 朱彩凤, 俞东容. 雷公藤制剂治疗IgA肾病的现状及展望. 浙江中医药大学学报, 2008, 32(4):556-558.
26. 沈世忠, 杨忠民, 胡义阳, 等. 雷公藤多苷对IgA肾病CD4+ CD25 high调节性T细胞及Th1、Th2影响. 中国中西医结合肾病杂志, 2013, 14(11):979-982.
27. 杜晓刚, 甘华. PDGF在肾脏疾病中的研究进展. 医学综述, 2001, (1):39.
28. 张雯, 程军, 陶筱娟, 等. 雷公藤多甙对IgA肾病小鼠肾皮质PDGF-B及受体表达的影响. 中国中医药科技, 2008, 15(5):347-348.
29. 张鑫. 雷公藤制剂毒副作用及减毒方法研究进展. 中国药学杂志, 2013, 48(22):1897-1901.

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Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Tripterygium Wilfordii Hook F for IgA Nephropathy: A Meta-analysis

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