Tripterygium Glycosides Combined With Glucocorticoid In The Treatment Of Henoch-Schonlein Purpura Nephritis: A Systematic Review And Meta-analysis

Objective:To evaluate the randomized controlled trials(RCTs) of Tripterygium glycosides(TG) combined with glucocorticoid(GC) in the treatment of Henoch-Schonlein purpura nephritis(HSPN)comprehensively and systematically by means of meta-analysis,in order to provide some research evidence for future clinical medication and related experimental studies.Methods:CNKI,Wan Fang Data,VIP,SinoMed,PubMed,EMbase and The Cochrane Library(up to Feb.12,2019),were searched to collect the RCTs on TG combined with GC for HSPN.Two researchers independently screened the literature according to inclusion criteria and exclusion criteria,extracted data,and evaluated the quality of the literature.After completion,cross-checking was performed.Meta-analysis was performed with RevMan5.3 statistical software,and subgroup analysis was performed for outcomes with different interventions and high heterogeneity.Results:2927 relevant literatures were retrieved and 37 were included.A total of 2808 patients were enrolled,including 1414 in the group with TG+GC and 1394 in the control group.All the clinical studies showed a low quality.Efficacy:In terms of complete remission rate,the group with TG+GC performed better than the control group(RR=1.38,95%CI[1.26,1.52],P<0.00001).In terms of total effective rate,the group with TG+GC performed better than the control group(RR=1.19,95%CI[1.14,1.25],P<0.00001).In terms of urinary protein negative time and urine occult blood negative time,the group with TG+GC performed better than the control group(MD=-8.01,95%CI[-10.10,-5.91],P<0.00001;MD=-17.33,95%CI[-26.16,-8.51],P=0.0001).In terms of recurrence rate,the group with TG+GC was lower than the control group(RR=0.14,95%CI[0.08,0.25],P<0,00001)'Safety:There was no significant difference in the incidence of total adverse reactions between the group with TG+GC and the control group(RR=0.85,95%C I[0.62,1.14],P=0.28).Adverse reactions reported in this study included gastrointestinal discomfort,liver damage,leucopenia,full moon face,increased hair,acne and menstrual disorders.According to the statistical results of this study,the incidence of gastrointestinal discomfort,leucopenia and liver damage was higher,but there was no significant difference between the two groups(RR=0.87,95%CI[0.55,1.36],,P=0.53;RR=1.52,95%CI[0.79,2.93],P=0.21;RR=1.09,95%CI[0.57,2.09],P=0.79).Conclusion:TG+GC for the treatment of HSPN can improve clinical efficacy,reduce recurrence,and the adverse reactions are relatively safe.Due to the generally low methodological quality of the included studies,which affected the accuracy and reliability of the result.Therefore,more high-quality,large samples and multi-center randomized controlled trials are necessary for further evidence.