Objective To systematically review the efficacy of total glycosides extracted from Rehmannia glutinosa Libosch leaf in the treatment of diabetic nephropathy. Methods Databases including PubMed, EMbase, MEDLINE, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP were electronically searched to collect randomized controlled trials of total glycosides from Rehmannia glutinosa Libosch for diabetic nephropathy from inception to May 30th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.4 software was then used to perform meta-analysis. Results A total of 7 RCTs involving 504 patients were included. The results of meta-analysis showed that there were no significant differences in creatinine levels (MD=?1.71, 95%CI ?3.97 to 0.56, P=0.14) and urea (MD=?0.18, 95%CI ?0.44 to 0.08, P=0.19) between the two groups. In terms of regulating proteinuria, the urinary albumin excretion rate (MD=?39.41, 95%CI ?48.46 to ?30.36, P<0.000 01), urinary microalbumin (MD＝?9.94, 95%CI ?12.16 to ?7.73, P<0.000 01), and 24-hour urinary protein (MD=?0.67, 95%CI ?0.85 to ?0.49, P<0.000 01) were all lower in the treatment group compared with control group. However, there were no differences between groups in terms of blood glucose metabolism as indicated by changes in levels of the long-term blood glucose metabolism indicator (HbA1c: MD=?0.16, 95%CI ?0.67 to 0.35, P=0.53). Only one study suggested that short-term blood glucose metabolism indicators, fasting blood glucose and postprandial blood glucose levels were not different between groups. In terms of blood lipid metabolism, only one study suggested glycoside treatment produced lower serum levels of cholesterol and triglycerides compared with control group. Conclusions Current evidence suggests that adjunctive therapy with total Rehmannia glutinosa Libosch glycosides can benefit diabetic nephropathy patients more than angiotensin II receptor inhibitor or pancreatic kininogen by alleviating proteinuria and likely improving lipid metabolism. However, no benefit is observed in terms of renal function improvement or blood glucose metabolism. Due to limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusions.
目的 探討不同性別IgA腎病患者合并高尿酸血癥的臨床及腎臟病理特點。 方法 采用回顧性研究方法，將2008年1月－2010年12月收治的226例經腎活檢確診的原發性IgA腎病患者分為男性高尿酸血癥組、男性尿酸正常組、女性高尿酸血癥組及女性尿酸正常組4組，統計分析4組的臨床指標及病理指標。 結果 高尿酸血癥患病率男性（21.7%）高于女性（11.9%），差異有統計學意義（P＜0.01），尿檢異常型患病率男性（14.6%）高于女性（4.0%），差異有統計學意義（P＜0.01），女性LeeⅢ級的患病率（7.1%）高于男性（5.8%），差異有統計學意義（P＜0.01）；男性高尿酸血癥組的尿素氮高于尿酸正常組（P＜0.05），女性高尿酸血癥組的血尿素氮、血肌酐、胱抑素C、舒張壓、甘油三酯比尿酸正常者明顯增高（P＜0.01），女性高尿酸血癥組的高密度脂蛋白明顯高于男性組（P ＜0.01）。 結論 高尿酸血癥是IgA腎病的危險因素，可導致更嚴重的腎功能損害及腎臟病理損害，這種影響在不同性別中存在差異。
目的 總結反復黏膜感染的IgA腎病的臨床病理特點。 方法 采用單中心流行病學調查及回顧性研究，收集2006年1月－2009年12月253例經腎活檢確診為IgA腎病的住院患者的臨床病理資料，對114例反復黏膜感染的IgA腎病患者（A組）及139例偶發或從未發生黏膜感染的IgA腎病患者（B組）的臨床病理指標進行比較。 結果 A組患者年齡較B組小（t=2.913，P=0.004），臨床表現無明顯癥狀者比例較B組多，臨床分型以反復發作肉眼血尿型為多，病理分級較B組輕（Z=?2.042，P=0.041），IgA+IgM+C3沉積率高（P＜0.001）；B組IgA+IgG+C3沉積率高（P＜0.001），纖維連接蛋白沉積率高（P＜0.001）。 結論 反復黏膜感染的IgA腎病組患者年齡小，反復發作肉眼血尿型多，臨床表現及病理分級較輕；兩組FN沉積及免疫球蛋白沉積的主要類型不同，提示兩組發病機制可能有所不同。
Objective To provide evidence for clinical practice by assessing the effectiveness and safety of Ligustrazine for primary nephrotic syndrome. Methods We searched MEDLINE (1966.1-2002.12), EMBASE (1975-2002.12), CBM (1979.1-2002.12), Chinese Evidence-Based Medicine/Cochrane Centre Database (CEBM/CCD, Issue 4, 2002) , Cochrane Library, and SCI (1985-2002.12) and handsearched 15 kinds of journals (including Journal of Nephrology et al) (1980-2003.2) for the randomized controlled trials (RCTs).Jadad score was used to assess the quality of RCTs. The outcomes of short term and long term effectiveness, and adverse effect of the treatment were analyzed by RevMan 4.1. Results Thirteen RCTs involving 675 patients met inclusion criteria. Jadad scores of each trial was 1 point. Meta-analysis of 4 studies showed that Ligustrazine had significant better short term effect [OR 4.24, 95% confidence interval (CI) 1.76 to 10.19], lowered 24 h urine protein (OR -0.36, 95% CI -0.71 to -0.02), improved renal function [ creatinine level in children group: (OR -3.34, 95% CI -5.25 to -1.43), creatinine level in adult group: (OR -48.29, 95% CI -68.24 to -28.35)], and increased serum albumin level (OR 3.61, 95% CI 2.61 to 4.61). Whether Ligustrazine had long term side effect was not confirmed. No adequate evidence showed that Ligustrazine could reduce the relapse rate of primary nephrotic syndrome. Conclusions Meta-analysis of low quality RCTs suggest that Ligustrazine does work in primary nephritic syndrome in short term observation. No adequate evidence shows that Ligustrazine has severe side effect or can reduce the relapse rate of primary nephrotic syndrome. We can’t draw a conclusion that Ligustrazine is safe in primary nephrotic syndrome treatment.A rigorously designed, randomized, double blind, placebo controlled trial are required.
To diagnose and treat a patient with rare lupus erythematosus-like syndrome and antineutrophil cytoplasmic antibodies (ANCA) positive vasculitis with graves’ disease by applying the approach of evidence-based medicine. Clinical problems were raised based on the patient condition and PubMed (1966-2003), CBM (1978-2003), EMBASE (1974-2003) were searched for the related information. We found that the best explaination for this case was antithyroid drugs’ side effect, and the patient was obvious better after treatment.
Objective To assess the efficacy and safety of Rhubarb and adjunvent drugs for chronic renal failure. Methods Electronic database searching including Medline, Cochrane Library and CBM from 1980 to Dec., 2000 was performed. Handsearching was applied to 15 kinds of nephrological and traditional Chinese medicine journals such as Chinese Journal of Nephology. Randomised and quasi-randomised trials concerning Rhubarb treatment for CRF were selected. The selected studies were assessed for their methodological quality and the data were extracted to perform the Meta-analysis. Results Eighteen randomised and quasi-randomised trials including 1 322 patients met the inclusion criteria, but their methodological quality was low. Compared to non-specific treatment, Rhubarb showed significant positive effects on relieving symptoms, lowering serum creatinine, improving HGB and adjusting disturbance of lipid metabolism. The effect of Rhubarb on reducing the number of death [OR 0.15, 95%CI (0.06 to 0.36), P=0.000] and the number of progressing into end-stage renal disease [OR 0.38, 95%CI (0.09 to1.64), P=0.19] was not confirmed because of the small sample size. Conclusions Rhubarb may have the same effect on CRF in the short-term observation. But its long-term effect of delaying the progression of CRF is still unclear. Well designed, randomised, double-blinded, placebo-controlled trials with long-term follow up and clinical related outcomes are warranted.
Objective To assess the efficacy and safety of okra capsule for IgA nephropathy. Methods All randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) of okra capsule for IgA nephropathy were collected from CENTRAL, MEDLINE, EMbase, PubMed, WanFang Data, CNKI and CBM. Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross-checked then. Then RevMan 5.07 software was used for meta-analysis. Results Five RCTs were included. The results of meta-analyses showed that: compared with the control group, okra capsule was more effective in decreasing urinary protein (P≥0.05), but had no significant difference in improving renal function, reducing urine red blood cells and blood lipid (Plt;0.05). No research reported the adverse effects of okra capsule. Conclusion Current evidence reveals that okra capsule can reduce urinary protein and improving therapeutic effect for IgA nephropathy. However, further studies are needed to test its safety. Because of the small sample size and low methodological quality of the included studies, these results require more high-quality RCTs for further verification.
【摘要】為順應留學生教育規模的擴大和教學質量的穩步提升，通過幾年的留學生教學實踐和探索，立足留學生臨床專業教育培養目標，強化課程設置、師資培養、教材建設、教學手段、教學管理等多個教學環節的建設和推進，確保留學生臨床醫學課程教學質量的提高和可持續發展。【Abstract】To explore a better way to improve the quality of the clinical medical teaching for foreign students in China along with the expansion of the enrollment of international medical students, some experience are summarized, which include the establishment of the international education aim, the organization of courses, training of the teachers, the selection and reinforcement of teaching material, the enrichment of teaching methods and the strengthening of teaching management.
Objective To assess the effectiveness and safety of Shenling granule for lower urinary tract infection （damp-heat in lower-Jiao ） in comparison with Niaoganling Chongji. Methods A double-bhnd, double-dummy, randomized controlled trial was conducted. A total of 96 patients （damp-heat in lower-Jiao） were randomized to the treatment group （n =72, Shenling granule, 1 bag, rid） and the control group （n =24, Niaoganling Chongji, 1 bag, tid）. The therapeutic course for both groups was 1 week. Results ITT （intention-to-treatment） analysis showed that the total effective rates of the treatment group and the controlled group were 92.43% and 91.31% , respectively （P 〉0.05）. PP （perprotocol-population） analysis showed that they were 92.31% and 90.91% , respectively （ P 〉0.05 ）. The effective rates on Chinese medicine symptom of the treatment group and the controlled group were 93.43% and 95, 65% respectively by ITT analysis （ P 〉0.05 ） , 95.38% and 94.45% respectively by PP analysis （ P 〉0.05 ）, No significant difference between the two groups was detected. No adverse effect was found. Conclusions There is no significant difference between Shenling granule and Niaoganling Chongji in the treatment of patients with lower urinary tract infection. No adverse effect was found.
目的 探討抗核抗體（ANA）在IgA腎病中的陽性率及其對臨床的意義。 方法 回顧性分析2007年1月－2009年12月間進行ANA檢測的115例IgA腎病患者及59例非IgA腎病慢性腎炎患者的臨床資料。統計分析ANA陽性與陰性的臨床指標。 結果 IgA腎病患者中有12例（10.4%）存在ANA陽性，與非IgA腎病慢性腎炎中的陽性率比較差異無統計學意義（P＞0.05），ANA陽性的IgA腎病血漿IgG水平較高，病理改變較輕。 結論 IgA腎病ANA陽性的機體免疫有增強，腎功、尿蛋白及病理損害較輕，其對IgA腎病預后的影響仍需進一步研究。