Meta-Analysis Of Tonifying Kidney And Activating Blood Circulation Therapy For IgA Nephropathy And Study On The Medication Law Of Professor Zhang Daning For IgA Nephropathy

Objective:This study Meta-analyzed the clinical randomized controlled trials of the therapy of tonifying Kidney and activating blood circulation for Ig A nephropathy,and conducted an in-depth analysis through data mining technology on the medication law of Professor Zhang Daning’s prescriptions for Ig A nephropathy patients.So as to provide reliable clinical basis for this therapy from the perspective of evidence-based medicine,and make the precious experience of Professor Zhang Daning in the treatment of Ig A nephropathy inherited and carried forward.Method:1.RCT literatures about the therapy of tonifying Kidney and activating blood circulation for Ig A nephropathy were collected from CNKI、VIP、WAN-FANG DATA、CBM-Disc、Pub Med 、 EMBASE and Cochrane library databases.The methodological quality of the literatures was evaluated by Cochrane and JADAD scales,and the extracted data was Meta analyzed by Revman 5.3 and Stata 12.2.The prescriptions of Ig A nephropathy patients treated by Professor Zhang Daning who met the inclusion criteria during January 2014 to December 2019 were collected.The extracted data was recorded into the software called Traditional Chinese Medicine Inheritance Support System v2.5 after standardized processing.Based on the data mining technology in the system,this paper made a systematic analysis on Professor Zhang Daning’s prescriptions of Ig A nephropathy patients,excavated the deep-seated medication rules and summarized Zhang Daning’s experience in the treatment of Ig A nephropathy.Result:1.(1)442 literatures were collected from the databases mentioned above,and 12 RCT studies including 1176 patients,with sample sizes ranging from 28 to 320 were finally included in Meta-analysis.All literatures met the baseline data consistency.Randomization was mentioned in 12 studies and 4 studies showed the details about the random assignment schemes.1 study mentioned the use of random assignment concealment anddouble-blindness.4 studies mentioned the case falling off,and the reason was specifically reported.None of the studies reported the results selectively and none of the studies mentioned the bias from other sources.According to the modified JADAD score,there were 4high-quality studies and 8 low-quality studies.The overall quality of the literature is generally low.(2)Meta-analysis showed that the treatment group using combined treatment of western medicine and TCM therapy by tonifying Kidney and activating blood circulation had better clinical efficacy compared with the western medicine control group[RR=1.36,95%CI(1.27,1.45),P<0.00001 ],which had advantages in decreasing the urine RBC count[MD=-9.64(-12.98,-6.30),P<0.00001],24-hour urine protein quantification [MD=-0.40,95%CI(-0.68,-0.13),P=0.004],creatinine[MD=-6.31,95%CI(-6.86,-5.76),P<0.00001],plasma Ig A[MD=-4.61,95%CI(-6.71,-2.50),P<0.0001]and improving TCM syndrome score[MD=-4.17,95%CI(-6.43,-1.92)P=0.0003].There was no statistical difference between two groups in decreasing urea nitrogen[MD=-1.27,95%CI(-3.11,0.56),P=0.17],increasing EGFR[MD=4.07,95%CI(-3.39,11.53),P=0.28]and increasing plasma albumin[MD=1.75,95%=CI(-0.93,4.42),P=0.20].2.A total of 175 prescriptions of Ig A nephropathy patients were included in this study,involving 99 flavors of traditional Chinese medicine,with 3402 times of the drug use frequency.Drugs which used more than 100 times were Astragalus membranaceus,Salvia miltiorrhiza,Ligusticum wallichii rhizome,Schisandra chinensis,Smilax glabra rhizome,Amomum villosum,Cohosh,Dandelion and Curcuma zedoary.Drugs of warm nature were most commonly used,followed by drugs of cold nature and drugs of neutral nature.Meanwhile the frequency of sweet,bitter and acrid drug flavor was relatively high.The main meridian tropism were liver meridian of foot-Jue yin,spleen meridian of foot-Tai yin,stomach meridian of Foot-Yang ming and Kidney meridian of foot-Shao yin.According to the analysis of association rules,drugs commonly used in prescriptions of Ig A nephropathy patients by Professor Zhang Daning were Astragalus membranaceus,Salvia miltiorrhiza,Ligusticum wallichii rhizome,Schisandra chinensis,Smilax glabra rhizome,Amomum villosum,Cohosh,Dandelion,Curcuma zedoary,Shepherd’s purse inflorescence,andDendrobium.5 core combinations of drugs and 5 new prescriptions for the treatment of Ig A nephropathy patients were excavated through entropy clustering analysis.Conclusion:1.The therapy of tonifying Kidney and activating blood circulation has a better clinical efficacy compared with the simple western medicine treatment,especially in reducing proteinuria、creatinine、plasma Ig A and improving TCM syndrome score.It suggests that this therapy is a promising option for the treatment of Ig A nephropathy,which is worth further exploration.While the efficacy in decreasing blood urea nitrogen,improving EGFR and plasma albumin remains unclear owing to the insufficient data available.Since the low overall quality of the included literature,more rigorous designed randomized trials of larger sample is needed to confirm the efficacy and safety of the therapy of tonifying Kidney and activating blood circulation in the treatment of Ig A nephropathy.2.This paper conducted an in-depth analysis on the medication law of Professor Zhang Daning’s prescriptions for Ig A nephropathy patients,concluding that the therapy of tonifying Kidney and activating blood circulation,clearing away heat and removing dampness had been used in the core combinations of drugs and the new prescriptions of the treatment.It provides a new way to make the treatment of Ig A nephropathy more standardized and effective in clinical practice,and make the precious experience of masters of Traditional Chinese Medicine passed down from generation to generation.