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, 劉莉. 作用于免疫系統的藥物. 楊世杰, 主編. 藥理學. 第2版. 北京:人民衛生出版社, 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.	陳耀龍, 蔡羽嘉, 王夢書, 等. 循證醫學術語介紹Ⅱ. 中國循證醫學雜志, 2009, 9(2):143-146.
9.	吳泰相, 商洪才, 卞兆祥. 隨機對照實況試驗的概念, 設計和實施. 中國循證醫學雜志, 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.	陳耀龍, 李曉, 梅又文, 等. 循證醫學術語介紹V. 中國循證醫學雜志, 2009, 9(7):734-739.
12.	王丹, 翟俊霞, 牟振云, 等. Meta分析中的異質性及其處理方法. 中國循證醫學雜志, 2009, 9(10):1115-1118.
13.	沈水娟, 胡作祥, 王時敏, 等. 雷公藤多苷片聯合苯那普利治療IgA腎病的療效觀察. 中國中西醫結合腎病雜志, 2009, 10(2):154-155.
14.	陳英, 覃英. 三聯療法治療中等量蛋白尿IgA腎病臨床療效觀察. 現代醫藥衛生, 2009, 25(11):1645-1646.
15.	沈良儒, 張麗麗, 池本香, 等. 雙倍劑量的雷公藤多苷在IgA腎病治療中的療效觀察. 右江醫學, 2011, 39(2):142-144.
16.	陳喜生. 嗎替麥考酚酯聯合雷公藤多甙治療IgA腎病的臨床療效觀察. 醫學臨床研究, 2011, 28(7):1295-1296.
17.	周學華, 姚春陽. 雷公藤多苷治療IgA腎病30例的臨床研究. 藥物與臨床, 2010, 48(30):34-35.
18.	謝彤, 鐘應雄, 麥偉民, 等. 雷公藤多苷治療IgA腎病的臨床研究. 中國醫師進修雜志, 2008, 31(1):35-36.
19.	張慧儒. 雷公藤多苷聯合嗎替麥考酚酯治療老年IgA腎病的療效觀察. 中國醫藥導報, 2013, 10(1):81-82.
20.	楊福燕, 魏崇一, 李超英. 雷公藤多甙治療非腎病綜合征IgA腎病對照研究. 中華全科醫學, 2008, 6(11):1138-1139.
21.	李艷玲. 雷公藤多苷聯合嗎替麥考酚酯治療IgA腎病的臨床研究. 中國醫藥科學, 2012, 2(8):62-103.
22.	曹珊, 陳清萍. 雷公藤多苷片聯合纈沙坦治療IgA腎病蛋白尿的療效. 實用臨床醫學, 2012, 13(11):9-10.
23.	Donadio JV, Grande JP. IgA nephropathy. N Engl J Med, 2002, 347(10):738-748.
24.	韋慧琴, 李良. IgA腎病的發病機制及治療研究進展. 內科, 2011, 6(3):252-254.
25.	李建秋, 朱彩鳳, 俞東容. 雷公藤制劑治療IgA腎病的現狀及展望. 浙江中醫藥大學學報, 2008, 32(4):556-558.
26.	沈世忠, 楊忠民, 胡義陽, 等. 雷公藤多苷對IgA腎病CD4+ CD25 high調節性T細胞及Th1、Th2影響. 中國中西醫結合腎病雜志, 2013, 14(11):979-982.
27.	杜曉剛, 甘華. PDGF在腎臟疾病中的研究進展. 醫學綜述, 2001, (1):39.
28.	張雯, 程軍, 陶筱娟, 等. 雷公藤多甙對IgA腎病小鼠腎皮質PDGF-B及受體表達的影響. 中國中醫藥科技, 2008, 15(5):347-348.
29.	張鑫. 雷公藤制劑毒副作用及減毒方法研究進展. 中國藥學雜志, 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, 劉莉. 作用于免疫系統的藥物. 楊世杰, 主編. 藥理學. 第2版. 北京:人民衛生出版社, 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. 陳耀龍, 蔡羽嘉, 王夢書, 等. 循證醫學術語介紹Ⅱ. 中國循證醫學雜志, 2009, 9(2):143-146.
9. 吳泰相, 商洪才, 卞兆祥. 隨機對照實況試驗的概念, 設計和實施. 中國循證醫學雜志, 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. 陳耀龍, 李曉, 梅又文, 等. 循證醫學術語介紹V. 中國循證醫學雜志, 2009, 9(7):734-739.
12. 王丹, 翟俊霞, 牟振云, 等. Meta分析中的異質性及其處理方法. 中國循證醫學雜志, 2009, 9(10):1115-1118.
13. 沈水娟, 胡作祥, 王時敏, 等. 雷公藤多苷片聯合苯那普利治療IgA腎病的療效觀察. 中國中西醫結合腎病雜志, 2009, 10(2):154-155.
14. 陳英, 覃英. 三聯療法治療中等量蛋白尿IgA腎病臨床療效觀察. 現代醫藥衛生, 2009, 25(11):1645-1646.
15. 沈良儒, 張麗麗, 池本香, 等. 雙倍劑量的雷公藤多苷在IgA腎病治療中的療效觀察. 右江醫學, 2011, 39(2):142-144.
16. 陳喜生. 嗎替麥考酚酯聯合雷公藤多甙治療IgA腎病的臨床療效觀察. 醫學臨床研究, 2011, 28(7):1295-1296.
17. 周學華, 姚春陽. 雷公藤多苷治療IgA腎病30例的臨床研究. 藥物與臨床, 2010, 48(30):34-35.
18. 謝彤, 鐘應雄, 麥偉民, 等. 雷公藤多苷治療IgA腎病的臨床研究. 中國醫師進修雜志, 2008, 31(1):35-36.
19. 張慧儒. 雷公藤多苷聯合嗎替麥考酚酯治療老年IgA腎病的療效觀察. 中國醫藥導報, 2013, 10(1):81-82.
20. 楊福燕, 魏崇一, 李超英. 雷公藤多甙治療非腎病綜合征IgA腎病對照研究. 中華全科醫學, 2008, 6(11):1138-1139.
21. 李艷玲. 雷公藤多苷聯合嗎替麥考酚酯治療IgA腎病的臨床研究. 中國醫藥科學, 2012, 2(8):62-103.
22. 曹珊, 陳清萍. 雷公藤多苷片聯合纈沙坦治療IgA腎病蛋白尿的療效. 實用臨床醫學, 2012, 13(11):9-10.
23. Donadio JV, Grande JP. IgA nephropathy. N Engl J Med, 2002, 347(10):738-748.
24. 韋慧琴, 李良. IgA腎病的發病機制及治療研究進展. 內科, 2011, 6(3):252-254.
25. 李建秋, 朱彩鳳, 俞東容. 雷公藤制劑治療IgA腎病的現狀及展望. 浙江中醫藥大學學報, 2008, 32(4):556-558.
26. 沈世忠, 楊忠民, 胡義陽, 等. 雷公藤多苷對IgA腎病CD4+ CD25 high調節性T細胞及Th1、Th2影響. 中國中西醫結合腎病雜志, 2013, 14(11):979-982.
27. 杜曉剛, 甘華. PDGF在腎臟疾病中的研究進展. 醫學綜述, 2001, (1):39.
28. 張雯, 程軍, 陶筱娟, 等. 雷公藤多甙對IgA腎病小鼠腎皮質PDGF-B及受體表達的影響. 中國中醫藥科技, 2008, 15(5):347-348.
29. 張鑫. 雷公藤制劑毒副作用及減毒方法研究進展. 中國藥學雜志, 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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