Efficacy and Safety of Tanshinone for Chronic Kidney Disease: A Meta-Analysis

Zhou, Yao; Jiang, Shi-min; Li, Li; Wang, Ying; Ding, Lei; Liu, Chao-xia; Wu, Qi; Gao, Kun

doi:https://doi.org/10.1155/2020/3091814

Evidence-Based Complementary and Alternative Medicine

On this page

Abstract Introduction Data and Methods Results Discussion Conclusion Data Availability Disclosure Conflicts of Interest Authors’ Contributions Acknowledgments References Copyright Related Articles

Research Article | Open Access

Volume 2020 | Article ID 3091814 | https://doi.org/10.1155/2020/3091814

Efficacy and Safety of Tanshinone for Chronic Kidney Disease: A Meta-Analysis

Yao Zhou,^1,2Shi-min Jiang,^1,2Li Li,¹Ying Wang,¹Lei Ding,¹Chao-xia Liu,¹Qi Wu,³and Kun Gao^4,5

Academic Editor: Ronald Sherman

Received30 Aug 2019

Revised02 Dec 2019

Accepted10 Dec 2019

Published13 Jan 2020

Abstract

Objective. To systematically evaluate the efficacy and safety of tanshinone for chronic kidney disease (CKD). Methods. Randomized controlled trials (RCTs) on the treatment of CKD using tanshinone were searched using 4 Chinese databases (China National Knowledge Infrastructure (CNKI), Value In Paper (VIP), Wanfang, and Chinese Biology Medicine (CBM)) and 3 English databases (PubMed, Cochrane Library, and Excerpta Medica Database (Embase)). The results included data on blood urine nitrogen (BUN), serum creatinine (Scr), glomerular filtration rate (GFR), 24 h urine protein, microalbuminuria (mALB), β2-macroglobulin (β2-MG), cystatin C (CysC), and safety events. The data were analyzed using Revman 5.3 and Stata 12.0 software. Results. Twenty-one studies were entered into this meta-analysis, which involved 1857 patients including 954 cases from the tanshinone treatment group and 903 cases from the control group. BUN levels in the tanshinone treatment group were significantly reduced compared with the control (standardized mean difference (SMD) = −0.65, 95% confidence interval (CI): −0.81 to −0.49, ). In addition, subgroup analysis indicated that tanshinone had a significant effect in reducing Scr levels at 14, 21, and 28 days. Scr levels in the tanshinone treatment group were significantly reduced compared with the control group (SMD = −1.40, 95% CI: −2.09 to −0.71, ); subgroup analysis based on treatment time also yielded the same results. GFR in the tanshinone treatment group was better than that in the control group (SMD = 0.83, 95% CI: 0.59 to 1.07, ). In terms of urine protein levels, 24 h urine protein level, mALB, and β2-MG of CKD patients were reduced to some degree compared with controls, and CysC levels in the tanshinone treatment group were also significantly reduced compared with the control group (SMD = −0.24, 95% CI: −0.44 to −0.03, ). Safety in the tanshinone treatment group did not differ significantly from that of the control group (risk ratio (RR) = 7.78, 95% CI: 0.99 to 61.05, ). Conclusion. This meta-analysis showed that tanshinone could control urine protein level in CKD patients, improve kidney function, and delay the evolution of CKD without significant side effects. However, the results were limited and should be interpreted with caution because of the low quality of the included studies. In the future, more rigorous clinical trials need to be conducted to provide sufficient and accurate evidence.

1. Introduction

Chronic kidney disease (CKD) is a condition of functional and structural dysfunction of the kidney with impairment longer than 3 months, caused by various factors. It is characterized by normal or abnormal glomerular filtration rate (GFR) from pathological glomerular injury, abnormal renal function indices in urine or blood, abnormal imaging findings, or decreased GFR for more than 3 months of unknown etiology (<60 mL/min·1.73 m²) [1]. With increasing life expectancy and parallel increases in the standard of living, the incidence of metabolic diseases such as diabetes, hyperlipidemia, and hypertension is consistently on the rise, leading to annual increases in the incidence of CKD [2].

However, there are presently no effective drugs for treating CKD. CKD is treated mainly with hormone therapy and immune suppressors in addition to control urine protein, blood pressure, and blood glucose levels and maintaining homeostasis. Although these therapies can reduce kidney impairment to a certain degree, they are unable to radically delay the evolution of this disease. Furthermore, hormone and immune suppressors are only effective in part of the pathogenesis of kidney injury and lead to high rates of relapse. Their long-term application can also lead to severe infection and osteonecrosis of the femoral head, among other side effects [3, 4]. Therefore, safe and efficacious drugs are needed for CKD treatment. Tanshinone is the main active ingredient of the frequently used traditional Chinese medicine Danshen. This agent functions to protect body tissues by inducing dilation of the cardiocerebral-renal vasculature, increasing blood flow to ischemic myocardial tissue, scavenging reactive oxygen species (ROS) resulting from lipid peroxidation during organ ischemia/reperfusion injury, and inhibiting intracellular calcium overload. Tanshinone has been widely administered in patients with angina pectoris and myocardial infarction [5, 6]. However, research on CKD revealed that tanshinone can also protect the kidney and delay diabetes-related renal fibrosis [7]. Clinically, a number of studies have shown that tanshinone administration can restore a certain degree of kidney function in CKD patients, but this conclusion has yet to be confirmed.

In the present study, published randomized controlled studies (RCTs) on CKD treatment with tanshinone were found, and the efficacy and safety of tanshinone for CKD were systematically evaluated. The results of this meta-analysis provide some evidence for the clinical application of tanshinone.

2. Data and Methods

2.1. Literature Search

This search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for the conduct of meta-analyses of intervention studies [8]. Four Chinese databases (China National Knowledge Infrastructure (CNKI), Value In Paper (VIP), Wanfang, and Chinese Biology Medicine (CBM)) and 3 English databases (PubMed, Cochrane Library, and Excerpta Medica Database (Embase)) were used for the literature search. Conference papers and academic dissertations were searched manually. In cases where the information was incomplete, the corresponding authors of those papers were contacted and the information necessary for the meta-analysis was obtained. The literature search was concluded on June 1, 2019, and therefore included papers published before this date.

The search terms used were (Tanshinone OR Salvia OR Miltiorrhiza OR Danshentong OR Tanshinone IIA OR Tanshinone IIB OR Tanshinone Injection OR Tanshinone Capsule OR Salvia Injection OR Salvia Capsule OR Miltiorrhiza Injection OR Miltiorrhiza Capsule OR Danshentong Injection OR Danshentong Capsule) AND (CKD OR Chronic Kidney Disease OR Kidney Diseases OR Kidney Insufficiency OR Chronic Kidney Failure OR End-stage Kidney Disease OR End-stage Kidney Failure OR Kidney Injury OR Diabetic Kidney Disease OR Hypertensive Kidney Disease OR Kidney Dialysis OR Chronic Renal Disease OR Renal Diseases OR Renal Insufficiency OR Chronic Renal Failure OR End-stage Renal Disease OR End-stage Renal Failure OR Renal Injury OR Diabetic Renal Disease OR Hypertensive Renal Disease OR Renal Dialysis OR Nephrosis OR Diabetic Nephropathy OR Hypertensive Nephropathy OR Nephrotic Syndrome OR Kidney Transplantation OR Cardiorenal Syndrome).

2.2. Criteria for Literature Inclusion

2.2.1. Type of Research

RCTs about CKD treatment with tanshinone published domestically and abroad before June 1, 2019, were included.

2.2.2. Study Subjects

The subjects in the RCTs were patients diagnosed with CKD. Diagnostic criteria were based on the relevant guidelines for CKD diagnosis and treatment.

2.2.3. Preventative Measures

The treatment group comprised patients treated with tanshinone, and treatment with other medications plus tanshinone was also included. The control group was treated with placebo or conventional western medicine, and any form of tanshinone treatment was excluded.

2.2.4. Results

At least one of the following results was included: blood urine nitrogen (BUN), serum creatinine (Scr), glomerular filtration rate (GFR), 24 h urine protein, microalbuminuria (mALB), β2-macroglobulin (β2-MG), cystatin C (CysC), and safety events.

2.2.5. Criteria for Literature Exclusion

The exclusion criteria for literature were as follows: (1) cases not definitively diagnosed with CKD, (2) repeatedly published articles, (3) too little information reported to be useful, and (4) the number of cases and treatments not accurately provided.

2.3. Data Extraction

Data were extracted collaboratively by two researchers. They independently extracted data consistent with the study requirements, recorded the data sequentially in a prepared information sheet, and crosschecked the data. Disagreement was resolved by having a third party to make the decision.

2.4. Assessment of Literature Quality

The literature included in this meta-analysis was subject to quality assessment according to the Cochrane criteria [9, 10]. The assessed content included random design, blind concealment, blinding, completeness of the final data, selectively reported research results, and publication bias. The risk of each content was evaluated. The risk assessment table was produced using Revman 5.3 software.

2.5. Statistical Analysis

Stata 12.0 and Revman 5.3 software were both used to analyze the data. For consecutive variables, the mean value ± standard deviation (SD) and 95% confidence interval (CI) represented the efficacy of treatment. For binary outcome data, risk ratio (RR) was used to calculate the summary. Heterogeneity was tested by the chi-squared test and I² test. A random-effects model was used when a chi-squared test () or I² > 50% revealed significant evidence of homogeneity across the studies, or else a fixed-effects model was used. Publication bias was evaluated using Begg’s test. values less than 0.05 indicated statistical significance. If the number of included trials was sufficient, sensitivity analysis was used to assess the stability of the results.

3. Results

3.1. Results of Our Literature Search

Computer searches and manual searching resulted in 297 publications, of which 127 potentially eligible reports were identified. First, 69 articles were excluded based on identification of titles and abstracts. Next, 2 single-arm studies, 18 animal studies, 3 repeated publications, and 14 articles with uncertain diagnosis or preventative measures were excluded after reading the entire article. Finally, 21 studies were included in the meta-analysis (Figure 1).

3.2. Basic Characteristics of the Included Studies

In total, 21 studies were included in the present meta-analysis, which involved 1875 patients comprising 954 patients from the tanshinone treatment group and 903 patients from the control group. Authors, year of publication, treatment plan, sample size, course of treatment, and index of evaluation of each study are shown in Table 1.

3.3. Risk of Bias Assessment of the Literature Included in the Study

The 21 studies included in this analysis were all RCTs, but only 3 had detailed descriptions of the methods. One study had a double-blind design. None of the 21 studies had allocation concealment. We could not confirm any other forms of bias because the available information was insufficient. Assessment of bias risk of the studies in the meta-analysis is shown in Figures 2(a) and 2(b).

(a)

(b)

3.4. BUN

A total of 8 studies compared BUN levels between the tanshinone treatment group and control group. We classified these studies into different subgroups based on the time of tanshinone treatment, namely, 14, 21, and 28 days. As shown in Figure 3(a), there was low heterogeneity (I² = 32.7%, ), so a fixed-effects model was used to analyze the data. BUN levels in the tanshinone treatment group were significantly reduced compared with the control group (SMD = −0.65, 95% CI: −0.81 to −0.49, ). The results of subgroup analysis indicated that tanshinone had a significant effect in reducing BUN levels at 14, 21, and 28 days. As shown in Figure 3(b), Begg’s test showed that there was no publication bias ().

(a)

(b)

3.5. Scr

A total of 9 studies compared Scr levels between the tanshinone treatment group and control group. We classified these studies into different subgroups based on time of tanshinone treatment, namely, 14, 21, and 28 days. As shown in Figure 4(a), the random-effects model was used to analyze the data because of the high heterogeneity. Scr levels in the tanshinone treatment group were significantly reduced compared with the control group (SMD = −1.40, 95% CI: −2.09 to −0.71, ). Subgroup analysis indicated that tanshinone had a significant effect on reducing Scr levels for 14, 21, and 28 days. As shown in Figure 4(a), Begg’s test showed that there was no publication bias ().

(a)

(b)

3.6. GFR

A total of 4 studies compared GFR between the tanshinone treatment and control groups. As shown in Figure 5(a), there was low heterogeneity (I² = 0%, ), so the fixed-effects model was used to analyze the data. The tanshinone treatment group had better GFR than the control group (SMD = 0.83, 95% CI: 0.59 to 1.07, ). Begg’s test showed that there was no publication bias (; Figure 5(b)).

(a)

(b)

3.7. Quantification of 24 h Urine Protein

A total of 6 studies quantitatively compared the 24 h urine protein between the tanshinone treatment group and control group. As shown in Figure 6(a), the fixed-effects model was used to analyze the data because of low heterogeneity (I² = 35.7%, p > 0.1). Tanshinone significantly reduced 24 h urine protein level compared with the control group (SMD = −0.94, 95% CI: −1.11 to −0.78, ). Begg’s test indicated that there was no publication bias (; Figure 6(b)).

(a)

(b)

3.8. mALB

Two studies compared mALB between the tanshinone treatment group and control group. As shown in Figure 7(a), the fixed-effects model was used to analyze the data because of low heterogeneity (I² = 0%, ). Tanshinone significantly reduced mALB levels compared with the control group (SMD = −0.89, 95% CI: −1.14 to –0.65, ). Begg’s test suggested that there was no publication bias (; Figure 7(b)).

(a)

(b)

3.9. β2-MG

A total of 3 studies compared β2-MG between the tanshinone treatment and control groups. As shown in Figure 8(a), the fixed-effects model was used to analyze the data because of low heterogeneity (I² = 8.9%, ). Tanshinone significantly reduced β2-MG levels compared with the control group (SMD = −1.21, 95% CI: −1.52 to −0.89, ). Begg’s test also suggested that there was no publication bias (; Figure 8(b)).

(a)

(b)

3.10. CysC

A total of 3 studies compared CysC levels between the tanshinone treatment and control groups. As shown in Figure 8(a), the fixed-effects model was used to analyze the data because of low heterogeneity (I² = 21.1%, ). CysC content in the tanshinone treatment group was significantly lower than that of the control group (SMD = −0.24, 95% CI: −0.44 to –0.03, ). No publication bias was observed according to Begg’s test (; Figure 9(b)).

(a)

(b)

3.11. Safety

Two publications addressed the safety of tanshinone in treating CKD.

In terms of side effects, 1 article reported mild stomach upset in some patients, and in another study patients complained of slight dizziness, with facial flushing that did not affect treatment in another article. As shown in Figure 10(a), the fixed-effects model was used to analyze the data because of low heterogeneity (I² = 0%, ). Safety in the tanshinone treatment group did not differ significantly from that of the control group (RR = 7.78, 95% CI: 0.99 to 61.05, ). This suggested that no significant side effects occurred after the addition of tanshinone. Likewise, no publication bias was observed according to Begg’s test (; Figure 9(b)).

(a)

(b)

4. Discussion

Danshen is a perennial herbaceous plant belonging to the mint family Lamiaceae [31]. Its root is used as a traditional Chinese medicine that has been widely used clinically for the treatment of cardiovascular diseases. Tanshinone is the active ingredient of Danshen and contains more than 50 compounds such as liposoluble compound tanshinone I, tanshinone IIA, and tanshinone IIB as well as the water-soluble compounds salvianolic acid A, salvianolic acid B, and tanshinol [32], of which tanshinone IIB is the most active ingredient, and tanshinone IIA-sodium sulfonate injection is a water-soluble compound derived from the sulfonation of tanshinone, a diterpene quinone compound isolated from Danshen. Many studies have demonstrated its anti-inflammatory, antioxidative, and ROS scavenging activities [33, 34].

CKD is a clinically prevalent, chronic, noninfectious, progressive, and irreversible disease characterized mainly by decreasing GFR. Epidemiological evidence suggests that CKD is mainly the result of glomerular disease and vascular disease caused by diabetes among other reasons [35].

In the present meta-analysis, the effects of tanshinone on CKD were compared with those of the control groups in terms of the three indicators, BUN, Scr, and GFR. Taken together, the results showed that BUN levels significantly decreased in the tanshinone treatment group compared with the control group, and subgroup analysis based on treatment time yielded the same results. For all the CKD patients included in this meta-analysis, Scr levels decreased significantly, while GFR markedly increased. These results suggest that tanshinone protects the kidney in CKD patients and improves GFR.

A common clinical feature of CKD patients is persistent proteinuria. We first compared 24 h urine protein in the tanshinone treatment and control groups. The comparison revealed that tanshinone treatment significantly reduced urine protein, while Begg’s test showed that there was no publication bias, indicating that tanshinone effectively reduced urine protein level in CKD patients. To further confirm this, we reviewed literature on mALB, and the combined results showed that tanshinone effectively reduced the mALB levels in CKD patients. Next, we selected 2 publications on the effects of tanshinone treatment on β2-MG levels in CKD patients, and the combined data showed that tanshinone treatment significantly reduced β2-MG levels in CKD patients. These results indicate that tanshinone has a role in controlling proteinuria in patients with CKD.

Presently, CysC is considered an endogenous marker of GFR, reflecting to a certain extent the filtration capacity of the glomerulus [36]. CysC could be an index of renal function. Three studies on CysC were included in the present meta-analysis. The results showed that tanshinone significantly reduced CysC levels in CKD patients compared with those of the control group. Meanwhile, the results of Begg’s test did not indicate publication bias, so the results can be taken as credible. The results of the aforementioned studies suggest that tanshinone could effectively reduce CysC levels in CKD patients and thus protect the kidney.

Only 2 studies evaluated the safety of tanshinone. The combined results showed that there was no significant increase in the side effects seen after the addition of tanshinone, suggesting that tanshinone treatment is relatively safe and has few side effects.

Although the effects of tanshinone on CKD were evaluated using a multiple dimensional meta-analysis, there were some limitations. The quality of the literature included in this present meta-analysis was relatively low, which may have affected the reliability of the results. Although the included literature claimed to have a randomized controlled design, only 3 studies clearly explained their methods, and 1 study used the double-blinded method. When combining the Scr data, the subgroup was highly heterogeneous, which may have impacted the reliability of the results. Limited by language barriers, only Chinese and English databases were searched, and only Chinese studies were included in the meta-analysis, which may have affected the final results to a certain degree.

5. Conclusion

Tanshinone controls urine protein level in CKD patients, improves kidney function, and delays the progression of CKD. Meanwhile, no major adverse effects have been reported. However, this conclusion should be interpreted with caution because of the poor quality of the included trials. More rigorous clinical trials including double-blind, randomized, placebo-controlled designs are required to provide more accurate evidence for the future.

Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.

Disclosure

Yao Zhou and Shi-min Jiang are co-first authors.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors’ Contributions

Kun Gao conceived and designed this study. Yao Zhou, Qi Wu, and Shi-min Jiang performed the data extraction, analysis, and interpretation and wrote the initial draft. Li Li assisted with data interpretation. Yao Zhou and Shi-min Jiang contributed equally to this work.

Acknowledgments

This study was sponsored by the National Natural Science Foundation of China (Grant nos. 81673912 and 81873259) and the Outstanding Talent Research Funding of Xuzhou Medical University (Grant nos. D2019005 and D2019022).

References

V. Nair, C. Robinson-Cohen, M. R. Smith et al., “Growth differentiation factor-15 and risk of CKD progression,” Journal of the American Society of Nephrology, vol. 28, no. 7, pp. 2233–2240, 2017.
View at: Publisher Site | Google Scholar
M. Mateusz, J. Szulimowska, A. Skutnik et al., “Salivary biomarkers of oxidative stress in children with chronic kidney disease,” Journal of Clinical Medicine, vol. 7, no. 8, p. 209, 2018.
View at: Publisher Site | Google Scholar
V. Cecile and G. B. Piccoli, “Eating like a rainbow: the development of a visual aid for nutritional treatment of CKD patients. A South African project,” Nutrients, vol. 9, no. 5, p. 435, 2017.
View at: Publisher Site | Google Scholar
V. S. Potluri and R. D. Bloom, “Treating hepatitis C infection in patients with advanced CKD in the real world: time to refocus on what our real treatment goals should be,” Kidney International, vol. 94, no. 1, pp. 18–21, 2018.
View at: Publisher Site | Google Scholar
J. Chen, Y. Bi, L. Chen, Q. Zhang, and L. Xu, “Tanshinone IIA exerts neuroprotective effects on hippocampus-dependent cognitive impairments in diabetic rats by attenuating ER stress-induced apoptosis,” Biomedicine & Pharmacotherapy, vol. 104, no. 1, pp. 530–536, 2019.
View at: Publisher Site | Google Scholar
Q. Shang, H. Wang, S. Li, and H. Xu, “The effect of sodium tanshinone IIA sulfate and simvastatin on elevated serum levels of inflammatory markers in patients with coronary heart disease: a study protocol for a randomized controlled trial,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 756519, 8 pages, 2013.
View at: Publisher Site | Google Scholar
G. Chen, X. Zhang, C. Li, Y. Lin, Y. Meng, and S. Tang, “Role of the TGFβ/p65 pathway in tanshinone IIA-treated HBZY-1 cells,” Molecular Medicine Reports, vol. 10, no. 5, pp. 2471–2476, 2014.
View at: Publisher Site | Google Scholar
A. Liberati, D. G. Altman, J. Tetzlaff et al., “The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration,” BMJ, vol. 339, no. jul21 1, Article ID b2700, 2009.
View at: Publisher Site | Google Scholar
W. T. Ma, F. Nie, G. Q. Sun et al., “Effect of tanshinone combined with valsartan therapy on the renal injury and endothelial injury in patients with hypertension nephropathy,” Journal of Hainan Medical University, vol. 23, no. 8, pp. 1059–1062, 2017.
View at: Google Scholar
J. P. Higgins, D. G. Altman, P. C. Gøtzsche et al., “The Cochrane Collaboration's tool for assessing risk of bias in random trials.,” British Medical Journal, vol. 343, p. d5928, 2011.
View at: Publisher Site | Google Scholar
E. Yang and X. Y. Li, “Clinical observation of Tanshinone IIA sodium injection combined with corbrin capsules in treatment of renal vascular hypertension,” Drugs & Clinic, vol. 31, no. 3, pp. 315–319, 2016.
View at: Google Scholar
S. Y. Hu, “Effect of tanshinone combined with valsartan therapy on the renal function and inflammatory reaction in patients with hypertension nephropathy,” Research of Integrated Traditional Chinese and Western Medicine, vol. 9, no. 5, pp. 239-240, 2017.
View at: Google Scholar
Q. H. Li and J. Guo, “Effect of tanshinone injection combined with valsartan on patients with hypertensive renal damage,” Xin Jiang Medical Journal, vol. 47, no. 11, pp. 1304-1305, 2017.
View at: Google Scholar
G. Q. Cao, X. H. Xu, and R. Q. Han, “Effect of Irbesartan combined with tanshinone IIA therapy on the patients with hypertension nephropathy,” Chinese Journal of Clinical Rational Drug Use, vol. 7, no. 10, pp. 46-47, 2014.
View at: Google Scholar
M. S. Tuxunguli, “Clinical observation of valsartan combined with tanshinone injection in the treatment of 64 cases of hypertensive renal damage,” Guide of China Medicine, vol. 15, no. 2, pp. 3–5, 2017.
View at: Google Scholar
K. Li, “Effect of sodium tanshinone IIA sulfonate combined with alprostadil in patients with diabetic nephropathy and its influence on renal function,” Clinical Research and Practice, vol. 3, no. 18, pp. 121-122, 2018.
View at: Google Scholar
B. W. Gong, Y. L. Ji, and Q. Wang, “Effect of sodium tanshinone IIA sulfonate combined with alprostadil in patients with early diabetic nephropathy on blood glucose and renal function,” Chinese Journal of Traditional Medical Science and Technology, vol. 19, no. 4, pp. 354-355, 2012.
View at: Google Scholar
C. X. Li, “Effect of sodium tanshinone IIA sulfonate in patients with chronic renal failure,” Journal of Clinical Research, vol. 24, no. 6, pp. 1041-1042, 2007.
View at: Google Scholar
H. Gao and Y. Gao, “Clinical observation of sodium tanshinone IIA sulfonate in patients with chronic renal failure,” Shan Dong Medical Journal, vol. 51, no. 5, pp. 80-81, 2011.
View at: Google Scholar
L. Z. Yan, H. Yan, and C. L. Sun, “Effects of tanshinone IIa sulfonate on glomerular filtration rate and renal blood flow resistance index in 70 patients with chronic renal failure,” Seek Medical and Ask The Medicine, vol. 9, no. 8, p. 215, 2011.
View at: Google Scholar
X. F. Deng, “The influence of tanshinone IIA combined with atorvastatin therapy on the Biochemical indexes in patients with diabetic nephropathy,” Chinese Journal of Gerontology, vol. 31, no. 8, pp. 1330-1331, 2011.
View at: Google Scholar
W. Wang, “The effect of tanshinone and alprostadil on left ventricular hypertrophy in patients with chronic renal failure,” Journal of Shandong Medical College, vol. 36, no. 4, pp. 244–247, 2014.
View at: Google Scholar
W. P. Peng, Y. Z. Huang, D. P. Huang et al., “The effect of haikun shenxi capsule combined with tanshinone IIA sodium sulfonate on chronic renal failure,” Chinese Journal of Modern Drug Application, vol. 4, no. 1, pp. 123-124, 2010.
View at: Google Scholar
G. W. Wei, Y. Ding, H. Yang et al., “The influence of alprostadil combined with tanshinone IIA on the treatment of elderly patients with chronic renal failure,” Journal of Guiyang College of TCM, vol. 38, no. 6, pp. 21–23, 2016.
View at: Google Scholar
J. G. Xu, “The influence of alprostadil combined with tanshinone IIA on the treatment of patients with chronic renal failure,” Modern Medicine Journal of China, vol. 15, no. 11, pp. 49-50, 2013.
View at: Google Scholar
X. X. Wang, “The influence of Shenkang injection combined with tanshinone IIA on the treatment of patients with chronic renal failure,” Henan Medicine Research, vol. 27, no. 11, pp. 2069-2070, 2018.
View at: Google Scholar
T. Ping, “The effects of tanshinone IIA sulfonate on renal function and serum lipid in patients with nephrotic syndrome,” Chinses Modern Doctor, vol. 45, no. 11, p. 90, 2007.
View at: Google Scholar
J. L. Chen, D. H. Liu, and J. M. Lv, “The clinical analysis of tanshinone IIA sulfonate on renal function and serum lipid in patients with nephrotic syndrome,” Journal of Gannan Medical University, vol. 29, no. 4, pp. 575-576, 2009.
View at: Google Scholar
X. C. Liao, W. J. Liu, and H. Y. Yang, “Effect of sodium tanshinone IIA sulfonate on glomerular filtration rate in cardiorenal syndrome patients,” Journal of Traditional Chinese Medicine University of Hunan, vol. 29, no. 11, pp. 23-24, 2009.
View at: Google Scholar
J. Y. Gu, M. L. Liao, M. X. Gao et al., “Impact of the N-terminal pro-brainnatriuretie peptide and cystatin C on patients with early cardiorenal syndrome treated with Tanshinone,” China Medical Herald, vol. 10, no. 11, pp. 72–74, 2013.
View at: Google Scholar
W. Qian, Z. Wang, T. Xu et al., “Anti-apoptotic effects and mechanisms of salvianolic acid A on cardiomyocytes in ischemia-reperfusion injury,” Histology and Histopathology, vol. 34, no. 3, pp. 223–231, 2018.
View at: Google Scholar
J. Xue, X. Jin, X. Wan et al., “Effects and mechanism of tanshinone IIA in proliferation, apoptosis, and migration of human colon cancer cells,” Medical Science Monitor, vol. 25, pp. 47931–54800, 2019.
View at: Publisher Site | Google Scholar
W. Cheng, W. Xiang, S. Wang et al., “Tanshinone IIA ameliorates oxaliplatin-induced neurotoxicity via mitochondrial protection and autophagy promotion,” American Journal of Translational Research, vol. 11, no. 5, pp. 3140–3149, 2019.
View at: Google Scholar
Z. Wang, J. Li, J. Zhang, and X. Xie, “Sodium tanshinone IIA sulfonate inhibits proliferation, migration, invasion and inflammation in rheumatoid arthritis fibroblast-like synoviocytes,” International Immunopharmacology, vol. 73, pp. 370–378, 2019.
View at: Publisher Site | Google Scholar
L. Dai, A. R. Qureshi, A. Witasp, B. Lindholm, and P. Stenvinkel, “Early vascular ageing and cellular senescence in chronic kidney disease,” Computational and Structural Biotechnology Journal, vol. 17, pp. 721–729, 2019.
View at: Publisher Site | Google Scholar
E. Terpos, D. Christoulas, E. Kastritis et al., “The chronic kidney disease epidemiology collaboration cystatin C (CKD-EPI-CysC) equation has an independent prognostic value for overall survival in newly diagnosed patients with symptomatic multiple myeloma; is it time to change from MDRD to CKD-EPI-CysC equations,” European Journal of Haematology, vol. 91, no. 4, pp. 347–355, 2013.
View at: Google Scholar

Copyright

Copyright © 2020 Yao Zhou et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation

Download other formats

Order printed copies

Views

807

Downloads

853

Citations