Meta Analysis of Efficacy and Safety of Traditional Chinese Medicine Combined with Immunosuppressive Agents in the Treatment of IgA Nephropathy

Abstract

Objective: To systematically evaluate the efficacy and safety of traditional Chinese medicine combined with immunosuppressive agents in the treatment of IgA nephropathy. Methods: the randomized controlled trial (RCT) of traditional Chinese medicine combined with immunosuppressive agents in the treatment of IgA nephropathy published in the databases of CNKI, VIP, Wanfang Data knowledge service platform, CBM and PubMed were comprehensively searched by computer. The retrieval time was from the establishment of each database to August 2023. Two researchers independently screened the literature and extracted the original data. The bias risk assessment tool in the Cochrane systematic review manual was used to evaluate the quality methodology, and Revman manager 5.4 software was used for meta-analysis of the included studies. Results: a total of 248 articles were retrieved, and 17 articles were finally included after screening according to the nanodischarge criteria. The total sample size was 1 456, including 730 cases in the experimental group and 726 cases in the control group. The results of meta-analysis showed that traditional Chinese medicine combined with immunosuppressive agents in the treatment of IgA nephropathy could improve the clinical effective rate [OR=3.80, 95% CI (2.79, 5.17), Z=8.51, P<0.00001]; The 24-hour urinary protein quantitation (24hUPQ) was reduced [MD=-0.51, 95% CI (-0.68, -0.34), Z=5.93, P<0.00001]; Reduce the number of urinary red blood cells (U-RBC) [SMD=-1.88, 95% CI (-2.83, -0.93), z=3.87, P<0.0001]; Delay the deterioration of renal function and reduce the level of serum creatinine (SCR) [MD=-10.61, 95% CI (-13.98, -7.25), Z=6.18, P<0.00001]; It was helpful to restore glomerular filtration rate (GFR) [MD=7.79, 95% CI (3.42, 12.53), Z=3.34, P=0.0006], and the above differences were statistically significant (P<0.05). However, there was no significant difference between the two groups in reducing the level of urea nitrogen (BUN) (P=0.15). Conclusion: Traditional Chinese medicine combined with immunosuppressive agents in the treatment of IgA nephropathy is superior to western medicine alone in improving clinical efficacy, with less side effects and high safety. Because the quality of the included literatures is generally low, the number is small, and there is a certain degree of publication bias, high-quality, large sample, multi center clinical randomized controlled trials are needed to verify the above conclusions in the future.