| Background Tripterygium was first recorded in"Shen Nong’s Materia Medica",which has been used for the treatment of autoimmune diseases for more than 40 years,it is cheap and effective,and it’s suitable for Chinese national conditions.However,with the expansion of the clinical application of Tripterygium,its toxic and side effects have also appeared,and even limited the use of Tripterygium.And there is no Meta-analysis on the efficacy and safety of Tripterygium in the treatment of lupus nephritis.Objective To evaluate the efficacy and safety of Tripterygium in the treatment of lupus nephritis,and provide objective evidence for the clinical application of Tripterygium in lupus nephritis,and provide some basis and reference for the future related clinical drug use and experimental research.Methods Databases including CNKI,VIP,Wan Fang,NSTL,PubMed,The Cochrane Library,and Embase were searched to select the eligibility studies,which related to the treatment of Tripterygium on lupus nephritis,and all selected studies were published from the establishment of the library to February 2019.The experimental group was treated with Tripterygium alone or combined with western medicine,while the control group was treated with western medicine only."Lupus nephritis"and"Tripterygium"were searched as Chinese and English search subject terms,and the logical relationship of the Chinese subject terms was"OR".The relevant literature was retrieved by the search strategy of subject word plus free word.The logical relationship between the subject word was"and",and the logical relationship between the subject word and free word was"or",citation retrieval and reference retrieval were used as supplements.The literature was screened by two researchers and included in the research literature after the preliminary screening of reading title and abstract,and the re-screening of the full text,and then checked centrally.Those with differences discussed with each other or decided to choose after discussion with the third researcher.The procedure of literature quality evaluation is the same as that of literature screening,and the methodological quality of literature is evaluated by using the quality evaluation criteria recommended by Cochrane.RevMan5.3 software was used to complete the Meta analysis.In the heterogeneity test(X~2 test),those with less heterogeneity(P≥0.1,I~2≤50%)adopted the fixed effect model,and those with greater heterogeneity(P<0.1,I~2>50%)adopted the random effect model.For those with high heterogeneity,the sensitivity analysis was carried out by eliminating the literature one by one,and the source of heterogeneity was analyzed.Relative risk(RR)and its 95%confidence interval(CI)were used for statistical analysis of two classified variables,while mean difference(MD)and 95%confidence interval were used for continuous variables,P<0.05 was considered statistically significant.The overall efficiency,the incidence of adverse reactions,24-hour urine protein,serum creatinine,blood urea nitrogen,serum albumin,alexin C3 and SLEDAI(systemic lupus erythematosus disease activity index)score were seen as outcome indicators.Results A total of 9 articles containing 608 patients were included in the study,which published between 1993 and 2019,242 patients in the experimental group and 234 patients in the control group,112 men and 496 women.All the 9 papers were of low to medium quality.Except He Shenghu for the direct decoction of tripterygium wilfordii herbs,12-15g/d,slow fire fried for two hours,the rest of the studies included were Tripterygium glycosides,1~1.5mg/(kg﹒d),three times a day orally.The combined RR values[95%confidence interval]of each outcome index were overall efficiency 2.36[1.55,3.60]andtheincidenceofadversereactions0.47[0.32,0.70],respectively.The combined MD values[95%confidence interval]were 24h urine protein-0.13[-0.23,-0.03],serum creatinine-9.93[-17.94,-1.93],blood urea nitrogen-1.14[-2.13,-0.14],serum albumin 3.99[0.82,7.17],complement C3 0.13[-0.12,0.38],SLEDAI score-0.35[-0.97,0.28].Except that there was no significant difference in complement C3 and SLEDAI scores between the experimental group and the control group,the differences of the other outcome indicators between the two groups were statistically significant.In other words,the experimental group was better than the control group in improving overall efficacy,reducing adverse reactions,reducing 24h urine protein quantitative serum creatinine,blood urea nitrogen and improving serum albumin level,and was similar to the control group in relieving complement C3 and reducing SLEDAI score.The results showed that the treatment of experimental group was better in improving efficacy and reducing the occurrence of toxic and side effects than the control group.Conclusion Tripterygium alone or in combination with western medicine has obvious effect and good safety in treating lupus nephritis. |
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