Meta-Analysis of Tripterygium Wilfordii Hook F in the Immunosuppressive Treatment of IgA Nephropathy
Meta-Analysis of Tripterygium Wilfordii Hook F in the Immunosuppressive Treatment of IgA Nephropathy
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DOI：
10.2169/internalmedicine.49.3704
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发表时间：
2010-01-01
影响因子：
1.2
通讯作者：
Mei, Chang-Lin
中科院分区：
文献类型：
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作者：
Chen, Yi-Zhi;Gao, Qing;Mei, Chang-Lin
目的 二十年前，中国众多 IgA 肾病（IgAN）患者已从雷公藤红（TwHF）中受益。然而，迄今为止，还没有针对 IgAN 的这种疗法进行系统评价。 方法 我们首次对所有符合条件的随机临床试验 (RCT) 进行了荟萃分析，以评估 TwHF 对 IgAN 的效果。 2009 年 8 月，对八个电子数据库进行了系统检索。使用审查管理器 (RevMan) 5.0 版。 结果 (i) 纳入了 4 项符合条件的随机对照试验，共有 188 名受试者； (ii) 纳入的随机对照试验的有效性普遍可以接受； (iii) 与非 TwHF 治疗相比，TwHF 带来了完全缓解 (CR)（RR 1.53，95% CI 1.09 至 2.16，I-2= 12%）和完全缓解（TR）（RR 1.27，95% CI 1.08 至 1.48，I-2= 0%）的有利增加；并且这一结果得到了意向治疗分析的进一步证实； (iv) 利用亚组荟萃分析，TwHF 显着改善 IgAN 伴非肾病性蛋白尿，CR 增加（RR 1.80，95% CI 1.21 至 2.68，I-2= 0%）和 TR（RR 1.32，95% CI 1.11 至 1.57，I-2= 0%），尿蛋白尿减少排泄 (UPE) (MD -467.41 mg/24h, 95% CI - 633.99 至 -300.82, I-2= 0%)。同时，肾功能得到很好的保存（MD -2.66 mu mol/L，95% CI - 9.26 to 3.94，I-2= 0%）。 结论 虽然本荟萃分析的结果应谨慎解释并值得进一步研究，但 TwHF 无疑是一种有价值且有前途的 IgAN 免疫抑制疗法，这与大量大型临床和实验研究中不断积累的证据是一致的。
Objective Numerous Chinese patients with IgA nephropathy (IgAN) have benefited from Tripterygium wilfordii Hook F (TwHF) from two decades ago. However, to date there is no systematic evaluation of this remedy for IgAN.Methods We conducted a meta-analysis of all eligible randomized clinical trials (RCTs) to assess the effect of TwHF on IgAN for the first time. In August 2009 a systematic search was performed among eight electronic databases. Review Manager (RevMan) version 5.0 was used.Results (i) Four eligible RCTs with 188 participants were included; (ii) The validities of included RCTs were generally acceptable; (iii) TwHF brought about a favorable increase in complete remission (CR) (RR 1.53, 95% CI 1.09 to 2.16, I-2= 12%) and total remission (TR) (RR 1.27, 95% CI 1.08 to 1.48, I-2= 0%) compared with non-TwHF treatment; and this result was further confirmed by intention-to-treat analysis; (iv) Exploiting subgroup meta-analysis, TwHF led to significantly greater improvements of IgAN with non-nephrotic proteinuria with regard to the increase of CR (RR 1.80, 95% CI 1.21 to 2.68, I-2= 0%) and TR (RR 1.32, 95% CI 1.11 to 1.57, I-2= 0%), and decrease of urinary proteinuria excretion (UPE) (MD -467.41 mg/24h, 95% CI - 633.99 to -300.82, I-2= 0%). Meanwhile, the renal function was well preserved (MD -2.66 mu mol/L, 95% CI - 9.26 to 3.94, I-2= 0%).Conclusion Although the results of this meta-analysis should be interpreted with caution and warrant further investigation, TwHF was certainly a valuable and promising immunosuppressive remedy for IgAN, which was in accordance with the accruing evidence from numerous large clinical and experimental studies.