Tripterygium Glycosides For Primary Nephrotic Syndrome A Systematic Review

Objectives: (1)To assess the efficacy of Tripterygium glycosides (TII) alone for primary nephrotic syndrome (PNS) .(2)Whether Tripterygium glycosides can help to improve the effectiveness of prednisone and immunosuppressor for primary nephrotic syndrome. (3) Whether Tripterygium glycosides can help to reduce the side effect and recurrence rate of primary nephrotic syndrome.Methods: Searches were applied to the following electronic databases: Medline; Embase Database; Cochrane Library; CBMdisc; CEBM/CCD. Meanwhile, handsearch was applied in 12 kinds of Journal of Chinese traditional medicine and relevant nephrology and urology until November, 2002. Randomized controlled trials with at least one month for therapy and follow-up should be used. Data were extracted independently by two reviewers. The methodological quality of trails was assessed by the Jadad-Score. Statistical analysis were performed with RevMan4.1.Results: At first 216 papers were found. There were 141 papers for Tripterygium glycosides to treat PNS and 15 RCTs were eligible according to the inclusion criterion. All the RCTs were divided into two groups, group I (TII vs prednisone / immunosuppressor)includes 8 RCTs which have 307 patients and group II (TII and prednisone/ immunosuppressor vs prednisone/immunosuppressor )includes 7 RCTs which have 227 patients . Meta-analysis of group I showed that Tripterygium glycosides had no benefit in improving the effectiveness and decreasing 24h proteinuria and Scr than prednisone/ immunosuppressor. Meta-analysis of group II showed that Tripterygium glycosides can increase the total effective rate of therapy and are benifit to improve the effectiveness of prednisone or immunosuppressor.Two groups reveal that TII can reduce the side effect and recurrence rate ofPNS. "Funnel plot" show imsymmetry which relate to less quality in methology and samall in sample .Review's conclusion: TII (a traditional Chinese medicinal herb) may work in PNS. Chinese traditional medicine with Western medicine to treat PNS could improve the effection of treatment but there has not difference between TII and prednisone or immunosuppressor on patient with PNS. Due to the low quanity and limited time of treatment and follow-up,the power of evidence was low. So large sample RCTs with multiply-center should be carried out assess the effect of therapy in PNS.