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Efficacy and safety of Huaiqihuang granule as adjuvant treatment for primary nephrotic syndrome in children: a meta-analysis and systematic review

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Abstract

Background

Huaiqihuang (HQH) granule is a traditional Chinese herbal complex that has been used as an adjuvant treatment in clinics for the primary nephrotic syndrome (PNS) for many years. However, the effectiveness and safety of HQH have not been systematically discussed. This review aimed to evaluate the effectiveness and safety of HQH in paediatric patients with PNS.

Methods

The following databases were searched from inception to Mar 2019: MEDLINE, Cochrane Library, EMBASE, CNKI, Wanfang Database, the Chinese Scientific Journal Database and the Chinese biomedical literature service system. All the randomized controlled trials (RCTs) eligible for inclusion were included. The primary outcomes were relapse, infection, remission and adverse events. The secondary outcomes included serum immunoglobulin levels (IgA, IgG or IgM), T-lymphocyte subtype (CD3+ , CD4+ , CD8+ , CD4+ /CD8+), IL-10, TNF-α, TNF-γ, total cholesterol and time of proteinuria turning negative.

Results

Fourteen RCTs (885 patients) were identified. Treatment with HQH reduced the chance of relapse [relative risk (RR): 0.47; 95% CI: 0.34, 0.66; P < 0.001] and infections (RR: 0.47; 95% CI: 0.35, 0.62; P < 0.001). No significant difference was found in adverse events. HQH also increased the serum levels of IgA [weighted mean difference (WMD): 0.40; 95% CI: 0.20, 0.60; P < 0.001] and IgG (WMD: 1.58; 95% CI: 1.38–1.78; P < 0.001), as well as CD4+ [standard mean difference (SMD): 0.90; 95% CI: 0.12–1.68; P = 0.02], CD3+ (WMD: 4.04; 95% CI: 3.27–4.82; P < 0.001), and the CD4+/CD8+ratio (WMD: 0.31; 95% CI: 0.21–0.41; P < 0.001), but decreased the level of CD8+ cells (WMD: –3.39; 95% CI: −5.73–1.05; P = 0.004). No statistically significant difference was found in IgM (WMD: 0.05; 95% CI: −0.13, 0.24; P = 0.57).

Conclusions

HQH could reduce the rate of relapse and the frequency of infection in children with PNS. No apparent adverse effects were found. Moreover, the beneficial influence of HQH may act through immunomodulation. Additional multi-center, large-sample, high-quality studies are needed to confirm the effectiveness and safety of HQH.

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Acknowledgements

Author Jian-Hua Mao is a member of the Editorial Board for World Journal of Pediatrics. The paper was handled by the other Editor and has undergone rigrous peer review process. Author Jian-Hua Mao was not involved in the journal's review of, or decisions related to, this manuscript.

Funding

This study was supported by the National Natural Foundation of China (81470939 and 81770710), the Natural Science Foundation of Zhejiang Province (LH14H050002, LY15H050001), and the Zhejiang Medical and Health Science and Technology Project (2016KYB177).

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Authors and Affiliations

  1. Department of Nephrology, National Clinical Research Center For Child Health, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China

    Jiao Lin, Li-Min Huang, Jing-Jing Wang & Jian-Hua Mao

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Contributions

MJH was responsible for the conception, reviewed and revised the manuscript. LJ managed the literature searches, data extraction and wrote the first draft of the manuscript. HLM was responsible for the literature searches, data extraction and inclusion and exclusion of studies. WJJ was responsible for data extraction, paper writing and revision. All authors read and approved the final manuscript.

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Correspondence to Jian-Hua Mao.

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Lin, J., Huang, LM., Wang, JJ. et al. Efficacy and safety of Huaiqihuang granule as adjuvant treatment for primary nephrotic syndrome in children: a meta-analysis and systematic review. World J Pediatr 17, 242–252 (2021). https://doi.org/10.1007/s12519-020-00405-w

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