民族药理学相关性:雷公藤甲素(TP),雷公藤的主要生物活性成分(TWHF),具有解决TWHF在临床上治疗糖尿病肾病(DKD)的缺点的潜力。研究目的:我们进行了一项荟萃分析,以评估TP治疗DKD的疗效,并为TP的进一步临床应用提供坚实的证据。材料与方法:八个数据库(CNKI,VIP,CBM,万方,PubMed,WebofScience,EMBASE,和Cochrane图书馆)以电子方式搜索合格的研究,直到2020年10月17日。我们选择了使用TP与肾素-血管紧张素系统抑制剂或非功能性液体的动物实验研究,以按照纳入和排除标准治疗DKD。两名研究人员从纳入的研究中独立提取数据,并使用实验室动物实验系统评价中心的偏倚风险工具评估偏倚风险。固定效应荟萃分析,亚组分析,使用RevMan5.3软件进行meta回归。印版注册号:INPLASY2020100042。结果:共纳入26项研究。Meta分析显示TP显著降低白蛋白尿(14项研究;标准化均差SMD:-1.44[-1.65,-1.23],I2=87%),尿白蛋白/尿肌酐比值(UACR)(8项研究;SMD:-5.03[-5.74,-4.33],I2=84%),总蛋白尿(4项研究;SMD:-3.12[-3.75,-2.49],I2=0%),血清肌酐(18项研究;SMD:-0.30[-0.49,-0.12],I2=76%),和血尿素氮(12项研究;SMD:-0.40[-0.60,-0.20],I2值=55%)在DKD动物中,与车辆控制相比。然而,关于TP与肾素-血管紧张素系统(RAS)抑制剂在DKD治疗中的比较,在改善白蛋白尿方面没有显着差异(3项研究;SMD:-0.35[-0.72,0.02],I2=41%),血清肌酐(3项研究;SMD:-0.07[-0.62,0.48],I2=10%),和血尿素氮(2项研究;SMD:-0.35[-0.97,0.28],I2=0%)。值得注意的是,TP在降低UACR方面表现出更高的能力(2项研究;SMD:-0.66[-1.31,-0.01],I2=0%)和总蛋白尿(2项研究;SMD:-1.18[-1.86,-2049],I2=0%)。Meta回归表明TP降低DKD白蛋白尿的疗效与应用剂量相关。此外,在诊断为DKD后,未检测到TP和RAS抑制剂之间的白蛋白尿减弱的发表偏倚。系统审查注册:https://clinicaltrials.gov/,标识符INPLASY2020100042。
Ethnopharmacological Relevance:
Triptolide (TP), the primary biologically active ingredient of Tripterygium wilfordii Hook F (TWHF), possesses the potential to solve the shortcomings of TWHF in treating diabetic kidney disease (DKD) in the clinic. Aim of the Study: We conducted a meta-analysis to evaluate the efficacy of TP in treating DKD and offer solid evidence for further clinical applications of TP. Materials and Methods: Eight databases (CNKI, VIP, CBM, WanFang, PubMed, Web of Science, EMBASE, and Cochrane library) were electronically searched for eligible studies until October 17, 2020. We selected animal experimental studies using TP versus renin-angiotensin system inhibitors or nonfunctional liquids to treat DKD by following the inclusion and exclusion criteria. Two researchers independently extracted data from the included studies and assessed the risk of bias with the Systematic
Review Centre for Laboratory Animal Experimentation Risk of Bias tool. Fixed-effects meta-analyses, subgroup analyses, and meta-regression were conducted using RevMan 5.3 software. Inplasy registration number: INPLASY2020100042. Results: Twenty-six studies were included. Meta-analysis showed that TP significantly reduced albuminuria (14 studies; standardized mean difference SMD: -1.44 [-1.65, -1.23], I2 = 87%), urine albumin/urine creatinine ratio (UACR) (8 studies; SMD: -5.03 [-5.74, -4.33], I2 = 84%), total proteinuria (4 studies; SMD: -3.12 [-3.75, -2.49], I2 = 0%), serum creatinine (18 studies; SMD: -0.30 [-0.49, -0.12], I2 = 76%), and blood urea nitrogen (12 studies; SMD: -0.40 [-0.60, -0.20], I2 value = 55%) in DKD animals, compared to the vehicle control. However, on comparing TP to the renin-angiotensin system (RAS) inhibitors in DKD treatment, there was no marked difference in ameliorating albuminuria (3 studies; SMD: -0.35 [-0.72, 0.02], I2 = 41%), serum creatinine (3 studies; SMD: -0.07 [-0.62, 0.48], I2 = 10%), and blood urea nitrogen (2 studies; SMD: -0.35 [-0.97, 0.28], I2 = 0%). Of note, TP exhibited higher capacities in reducing UACR (2 studies; SMD: -0.66 [-1.31, -0.01], I2 = 0%) and total proteinuria (2 studies; SMD: -1.18 [-1.86, -2049], I2 = 0%). Meta-regression implicated that the efficacy of TP in reducing DKD albuminuria was associated with applied dosages. In addition, publication bias has not been detected on attenuating albuminuria between TP and RAS inhibitors after the diagnosis of DKD. Systematic
Review Registration: https://clinicaltrials.gov/, identifier INPLASY2020100042.