Combination therapy of tripterygium glycosides plus valsartan in diabetic nephropathy treatment: A systematic review and meta-analysis

摘要

Objective: To assess the efficacy and safety of the combination therapy of Chinese herbal medicines,tripterygium glycosides, plus valsartan for the treatment of diabetic nephropathy(DN).Methods: A comprehensive research of 12 electronic databases was performed. Data of the included studies were extracted and analyzed independently by two authors, and were synthesized using Review Manager(version 5.2) and Stata(version 12.0).Results: A total of 12 randomized controlled trials(RCTs) involving 829 patients were included. Pooled results showed that the combination therapy significantly increased total efficacy of DN patients [RR = 1.35,95% CI(1.22, 1.50), P < 0.001], the level of serum albumin [Mean difference(MD)= 3.87, 95% CI(3.12,4.62), P < 0.001], and significantly decreased 24 h urinary protein level [MD =-0.97, 95% CI(-1.19,-0.76), P < 0.001], urinary albumin-excretion rate [MD =-145.53, 95% CI(-227.95,-63.11), P < 0.001],and urinary β2-microglobuli level [MD =-11.86, 95% CI(-13.02,-10.69), P < 0.001]. No significant differences were found in levels of serum creatinine [MD =-0.26, 95% CI(-7.52, 7.00), P > 0.05), blood urea nitrogen [MD = 0.25, 95% CI(-0.23, 0.74), P > 0.05], and endogenous creatinine clearance rate[MD =-0.43, 95% CI(-3.48, 2.62), P > 0.05]. However, tripterygium glycosides plus valsartan seemed to exert higher adverse reaction rate than valsartan monotherapy [MD = 3.41, 95% CI(1.34, 8.66), P < 0.05].There were no publication bias for all of the pooled effect sizes.Conclusion: Combination therapy of tripterygium glycosides plus valsartan may be effective for the treatment of DN. However, the safety of the combination therapy need to be further confirmed.