Meta-Analysis Of Addition And Subtraction Of Xiaochaihu Decoction Combined With Western Medicine In The Treatment Of Adult Chronic Glomerulonephritis

OBJECTIVE:To systematically review the efficacy and safety of addition and subtraction of xiaochaihu decoction combined with western medicine for adult chronic glomerulonephritis.METHODS:By means of comprehensive computer retrieval,the Chinese and English literature database included: CNKI,VIP,CBM and PubMed,Cochrane Library,EMBASE,etc.The Chinese retrieval words included “Chronic glomerulonephritis”,“Xiaochaihu decoction”,“Random”.And the English retrieval words included “Glomerulonephritis”,“Xiao Chai Hu Tang”,“Randomized Controlled Trial”.The 24-hour urine protein quantification was used as the first outcome index.Complied with certain inclusion and exclusion criteria and ascertained the eligible randomized controlled trials.Cochrane bias risk assessment form was used for literature quality evaluation of eligible trials.Bias risk assessment diagram and meta-analysis were performed using the software RevMan5.3.The subgroup analysis and sensitivity analysis were needed to judge the stability of results if necessary.Forest plots were used to perform the endpoints.And funnel plots were used to assess the publication bias.RESULTS:20 literatures of randomized controlled trials were included,they were all from Chinese studies.The publication year was from 2010 to 2019.A total of 1667 patients,the xiaochaihu decoction group included 836 cases and the control group included 831 cases.The results of meta-analysis showed that:(1)A total of 17 studies reported 24-hour urine protein quantification of chronic glomerulonephritis patients,MD=-0.45,95%CI[-0.57,-0.33],P<0.00001;(2)12 studies reported blood urea nitrogen level,MD=-0.99,95%CI[-1.60,-0.38],P=0.002;(3)12 of which reported blood creatinine level,MD=-10.65,95%CI[-18.61,-2.68],P=0.009;(4)A total of 17 studies described the total clinical effective rate,OR=3.74,95%CI[2.80,5.02],P<0.00001;(5)7 studies described interleukin-4 level,MD=11.49,95%CI[7.60,15.39],P<0.00001;(6)7 of which described interleukin-17 level,MD=-59.41,95%CI[-68.05,-50.78],P<0.00001;(7)7 studies reported interferon-? level,MD=-8.32,95%CI[-11.31,-5.34],P<0.00001;(8)5 studies described glomerular filtration rate,MD=0.73,95%CI[0.67,0.79],P<0.00001;(9)3 studies reported the ratio of T helper 1 cell and T helper 2 cell,MD=-1.07,95%CI[-1.58,-0.56],P<0.0001;(10)3 studies described traditional Chinese medicine syndrome score,MD=-5.59,95%CI[-7.85,-3.34],P<0.00001;(11)3 studies reported the efficacy of symptom of dizzy,OR=3.78,95%CI[1.73,8.24],P=0.0008;(12)3 studies described the efficacy of symptom of bitter taste,OR=5.77,95%CI[2.07,16.09],P=0.0008;(13)In addition,3 studies reported the efficacy of symptom of dry pharynx,OR=3.89,95%CI[1.69,8.95],P=0.001.The results of all endpoints showed that the difference was statistically significant between the observation group and the control group(P<0.05).And no literature reported the adverse event,the incidence of adverse reactions between the experimental and control groups showed no statistical significance of the difference in two groups(P>0.05).CONCLUSION:Compared with the control groups,addition and subtraction of xiaochaihu decoction combined with western medicine could significantly reduce the 24-hour urine protein quantification of adult patients with chronic glomerulonephritis,decrease the level of blood urea nitrogen and blood creatinine,increase the total clinical effective rate,glomerular filtration rate and interleukin-4 level,reduce interleukin-17 level,interferon-? level and the ratio of T helper 1 cell and T helper 2 cell,improve the traditional Chinese medicine syndrome score and the efficacy of symptom of dizzy,bitter taste and dry pharynx.And this treatment was relative security.Therefore,the meta-analysis of this study can provide more dependable evidence-based medicine evidence than single study for clinical application of addition and subtraction of xiaochaihu decoction combined with western medicine in the treatment of adult chronic glomerulonephritis.