| Background:Anaphylactoid purpura is a small vasculitis disease,mainly characterized by the deposition of IgA in the blood vessel wall.The mainly clinical manifestations are skin purpura,abdominal pain,hematuria,proteinuria,joint pain,muscle soreness and other symptoms.When it further influence in the kidneys,which be called Henoch-Schonlein purpura nephritis(HSPN).In adult secondary nephritis,the incidence of this disease is in the second place,but in children,the disease run the first palce in the whole secondary nephritis.According to the latest epidemiological data,the incidence of purpuric nephritis is 40%-50%in western countries,and 29.1%-55.1%in China.Because the pathogenesis of purpuric nephritis is complicated and cumbersome,there is no perfect conclusion that has been uniformly recognized in the world,and thus its treatment methods are correspondingly diverse.At present,Chinese medicine has achieved remarkable results in the treatment of this disease,which has alleviated the clinical symptoms of patients and improved the clinical cure rate.At the same time,it has a good effect on the relief of side effects such as hormones and immunosuppress-sion.Based on this,we have prepared a comprehensive and extensive collection.Relevant literature on purpuric nephritis,custom-made rigorous and reasonable litera-ture inclusion and rejection criteria,and the appropriate evaluation criteria for the ev-aluation of effect indicators by reviewing the literature,and objectively evaluating the combination of traditional Chinese medicine and traditional Chinese medicine and Western medicine through statistical means-meta analysis The efficacy and results of the program,expand the sample size to better study the treatment of purpuric nephritis,in order to provide high-quality reference and help for clinical and related research.Objectives:Objectively and accurately analyze and evaluate the efficacy of traditional Chinese medicine in the clinical treatment of purpuric nephritis,and make reliable systematic evaluation evidence for clinical treatment in the future.Methods:First,the following commonly used Chinese databases were searched comprehend-sively and extensively:China Knowledge Network Database(CNKI),VIP Chinese Science and Technology Journal Database(VIP),Wanfang Database,and China Biomedical Literature Database(CBM).According to the search strategy in the developed program,a comprehensive randomized controlled clinical trial(RCT)for the treatment of purpuric nephritis with traditional Chinese medicine is conducted,and then the inclusion and exclusion criteria are carefully and rigorously screened,and the method for finalizing the included study is carried out.Academic quality assessment analysis.Then,the indicators and data needed for the evaluation are extracted from the final literature,and the Revman5.3 software is used to conduct meta-analysis of the required outcome indicators.The remaining indicators are rationally selected according to the actual situation of the data.Statistical analysis and evaluation,and scientific methodological,medical and ethical detailed explanation and discussion of the corresponding results.Finally,the final result of this paper is whether the traditional Chinese medicine treatment of purpuric nephritis has any curative effect,and the level of curative effect,how to relieve the specific indicators,and make detailed and reliable decision-making evidence for future clinical practice.Results:After strict definition and screening,the study eventually included 80 studies involving a total of 3,820 subjects.There were 2270 people in the experimental group and 1550 in the control group.The results of analysis of male,female,age,and outcome indicators are as follows:Total Effectiveness:76 of the 80 eligible studies that were eventually included reported total effective rate.The results of the analysis were:RR=2.93[2.45,3.05],P<0.00001,indicating that in the 76 studies Traditional Chinese medicine treatment can significantly improve the total effective rate of treatment of purpuric nephritis.Combined with the simple operation of traditional Chinese medicine,low price and high acceptance,it is concluded that the traditional Chinese medicine treatment of this disease is worthy of clinical recommendation.Improvements in rash:Five of the 80 eligible studies that were eventually included reported improvement in rash,and the five studies reported that the trial group had better treatment for rash improvement than the control group.After removing the heterogeneous Ma Yuanyuan 2014 study,the results were P=0.0003,I2=25%.The results suggest that Chinese medicine is effective in improving the rash of patients,but it still needs a lot of tests to verify it multiple times.24-hour proteinuria improvement:41 of the 80 eligible studies that were included in the final study reported improvement in 24-hour proteinuria and a meta-analysis of the results:95%Cl[-0.26,-0.23]P<0.00001,the difference was statistically significant,suggesting that the effect of reducing the 24-hour urine protein quantitation in the experimental group was better than that in the control group.However,due to the high heterogeneity,the difference analysis of the drug type was further carried out,and two sets of results were obtained.The I2 was 98%,indicating that the difference in dosage form did not cause heterogeneity.Hematuria improvement:30 of the 80 eligible studies that were included in the final study reported improvement in urinary red blood cells,and the results obtained after statistical analysis were:95%CI[-3.17,-2.21]P<0.00001,suggesting that the difference is statistically significant,indicating that the test group improved the hematuria better than the control group,and further analyzed the heterogeneity of the drug type,the difference did not disappear,indicating that the difference in dosage form did not cause heterogeneity.Hemagglutination improvement:9 of the 80 eligible studies that were eventually included reported improvement in hemagglutination,three of which reported improvement in platelet counts,and two studies reported D-dimers in patients.Improvements,two studies reported improvements in plasma fibrinogen,two studies reported improvements in activated partial prothrombin time,and two studies reported improvements in prothrombin time PT(s),all of which were The results of single-variance variance were compared.The results of the meta-test showed that the improvement of the above four blood coagulation indexes was better than that of the control group,and it was statistically significant.The quality is more reliable and worthy of clinical recommendation.IgA improvement:Only 4 studies reported improvement in blood IgA,and statistical analysis showed results:P=0.18,indicating that the reduction of blood IgA in the experimental group was not statistically significant compared with the control group.The number of reports in this ending is small,but there are reports in the literature that after the treatment of Chinese medicine by syndrome differentiation,the body's immune quality has improved,so in the future,we can pay attention to strengthen the comparison of immune proteins.Improvement of urinary ?2-MG and serum creatinine:There are few references in the two studies,and the data is limited.A total of 5 studies reported improvement of urinary?2-MG,and the results were P=0.003.The reduction of urinary ?2-MG and the improvement of serum creatinine in the test group were better than those in the control group,and the difference was statistically significant.However,due to the small amount of data,it is still worth exploring.It is necessary to further improve the research in this area and expect more research data to support this view.Adverse reactions:Nine of the 80 eligible studies that were eventually included used a total of 4 reporting methods to report adverse reactions in the trial.However,because the content of comparison and the form of data are different and the sample size is too small,it is difficult to carry out the merger,which is not enough for analysis.The clinical practice can be explained in combination with the doctor's experience and the physical condition of the patient.Conclusion:This study shows that Chinese medicine has a certain role in the treatment of purpuric nephritis,which is worthy of clinical recommendation in improving total efficiency,improving proteinuria and hematuria.Traditional Chinese medicine can alleviate blood coagulation in HSPN patients,and there is a certain effect on blood&urine IgA.However,due to the low quality of evidence in this study,the clinical recommendation has a low degree of power.In practice,it still needs to be weighed by doctors.After extensive literature reading,deletion,inclusion and data processing,it is found that the current clinical randomized controlled trials of traditional Chinese medicine for purpuric nephritis are still generally low in statistical methodological quality,and it is still urgent to improve the clinical trial level of relevant researchers.Providing higher quality raw materials for future evidence users,better assisting clinical practice,improving treatment rate,improving patient symptoms and improving patient quality of life. |
PDF Full Text Request