A Systematic Review Of The Immunosuppressive Chinese Patent Drugs In Treating IgA Nephropathy

ObjectivesTo assess the clinical efficacy and safety of the immunosuppressive Chinese patent drugs in treating IgA nephropathy.MethodsWe searched PubMed, EMBASE, CENTRAL, CBM, CNKI, VIP and WANFANG MED ONLINE for all relevant randomized clinicalled trials (RCTS). Date of searching limited in March,2012. We assessed the quality of evidences and abstracted the informations of the articles according to the rules of Cochrane systemic reviews. RevMan5.1and GRADE3.2.2software was used.Result14randomized controlled trials with819participants meet the inclusion criteria were identified. We didn’t carry out Meta-analysis because of the heterogeneity of the inclusion criteria, design, interventions and course of the treatment. Tripterygium wilfordii and Huangkui capsules showed some effect on decreasing the proteinuria. Huobahuagen tablets bring about a favorite decreasing of proteinuria, urine red blood cell counts and serum creatinine compared to the controlled group. The adverse effect of Tripterygium wilfordii mainly included liver damage and paramenia. A few participants in Huangkui capsule group felt mild abdominal distension. And the adverse effect of Huobahuagen tablets was still unknown.ConclusionAccording to the available small sample, low quality of RCTs, there is no strong evidence to support the using of immunosuppressive Chinese patent drugs in IgA nephropathy. More multi-centre, large sample RCTs are needed. Part Two Clinical Investigation ObjectivesTo study the distribution and the use of Chinese patent medicine of TCM Syndromes of IgA nephropathy patients in our hospital.MethodsFrom January2010to March2012out-patient clinics and wards of the Guangdong Provincial Hospital of TCM, we collected the patients with IgA nephropathy who were confirmed by renal biopsy. Totally75cases are collected. The patients’basic information (including gender, age), the distribution of the TCM syndromes and the use of Chinese patent medicine were analyzed retrospectively.Result1. There are20kinds of TCM Syndromes in the75patients of IgA nephropathy. The top five were the spleen-kidney qi deficiency, Damp-heat-stagnation-type (14cases,18.67%), the spleen-kidney qi deficiency (10cases,13.33%), kidney insufficiency with damp-heat (10cases,13.33%), qi-yin deficiency (9cases,12.00%), Deficiency of Yin with Damp-heat Symptom (6cases,8.00%), qi-yin deficiency, Damp-heat-stagnation-type (6cases,8.00%);2.There were47cases use the proprietary Chinese medicines. Among which there were25patients use only one kinds of proprietary Chinese medicines (33.33%). And there were18people use combination of two kinds of proprietary Chinese medicines (24.00%). The combination of three kinds of proprietary Chinese medicines, a total of four (5.34%). In the use of proprietary Chinese medicine, the utilization rate of top five were Sanqi oral solution (29%), the shenyankangfu tablet (15%), Tripterygium wilfordii (11%), Huangkui capsules (11%) bailing capsules (10%);3. The analysis of the use of proprietary Chinese medicine which with immunosuppressive show that the patient who use the Tripterygium wilfordii with damp-heat-stagnation syndrome were accounted for75%. The patients who take the Huangkui capsules, accompanied by damp-heat-stagnation syndrome were accounted for87.5%. The discrepancy of medicines and syndromes in Tripterygium wilfordii is25%, while in Huangkui capsules is12.5%.ConclusionThe TCM syndromes of75patients with IgA nephropathy were mostly deficiency syndrome accompanied with excess syndrome. The clinical use of proprietary Chinese medicines should match the patients’ actual situation. But there are also discrepancy of medicines and syndromes, which need to pay more attention by clinicians.