摘要
背景过度的炎性反应及肾纤维化是糖尿病肾病(DN)进展为终末期肾病(ESRD)的关键环节,但目前西医对DN的常规治疗在抗炎、抗纤维化方面效果不显著。临床应用当归补血汤作为抗炎、抗纤维化辅助治疗DN的疗效显著,但缺乏循证依据。目的系统研究当归补血汤在DN辅助治疗中的疗效和安全性。方法计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、The Cochrane Library、EMBase、中国临床试验注册中心(ChiCTR)、ClinicalTrials.gov,检索时间为建库至2020年12月。筛选关于当归补血汤辅助治疗DN的临床随机对照试验,其中对照组施以常规综合治疗,试验组在对照组基础上配合当归补血汤加减。采用Cochrane风险偏倚评估工具进行文献质量评价,并提取文献数据。采用RevMan 5.4软件进行统计学分析。结果共纳入文献10篇,包括879例患者。Meta分析结果显示,试验组总有效率高于对照组〔相对危险度(RR)=1.18,95%CI(1.10,1.28),P<0.0001〕,24 h尿蛋白定量、尿白蛋白排泄率、血肌酐、尿素氮低于对照组〔均数差(MD)=-69.22,95%CI(-76.96,-61.48),P<0.00001;MD=-31.32,95%CI(-59.87,-2.76),P=0.03;MD=-10.24,95%CI(-11.51,-8.98),P<0.00001;MD=-0.95,95%CI(-1.61,-0.29),P=0.005〕。两组不良反应发生率比较,差异无统计学意义〔RR=1.00,95%CI(0.30,3.34),P>0.05〕。结论当归补血汤辅助治疗DN的临床疗效显著,具有良好的安全性。
Background Excessive inflammatory response and renal fibrosis play key roles in the progression of diabetic nephropathy to end-stage renal disease.However,the usual western treatment for diabetic nephropathy has no significant anti-inflammatory and anti-fibrosis effects.Dangguibuxue Decoction(DD)is often used as an adjuvant therapy clinically due to its notable anti-inflammatory and anti-fibrosis effect,but there is a lack of relevant medical evidence.Objective To systematically study the efficacy and safety of DD as an adjuvant therapy for diabetic nephropathy.Methods Databases of CNKI,Wanfang Data,VIP,SinoMed,PubMed,The Cochrane Library,EMBase,ChiCTR,and ClinicalTrials.gov were searched from inception to December 2020 to identify randomized controlled trials(RCTs)regarding diabetic nephropathy patients treated by usual integrated treatment and modified DD compared with those treated by usual integrated treatment.Data extraction of the included RCTs were performed.The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate the methodological quality.Review Manager 5.4 was used for meta-analysis.Results A total of 10 RCTs meeting the inclusion criteria were included,involving 879 patients.The results of meta-analysis found that the combined therapy of usual integrated treatment with modified DD could further improve the overall response rate〔RR=1.18,95%CI(1.10,1.28),P<0.0001〕,reduce the 24-hour urinary protein quantification〔MD=-69.22,95%CI(-76.96,-61.48),P<0.00001〕and urinary albumin excretion rate〔MD=-31.32,95%CI(-59.87,-2.76),P=0.03〕,decrease the levels of serum creatinine〔MD=-10.24,95%CI(-11.51,-8.98),P<0.00001〕and urea nitrogen〔MD=-0.95,95%CI(-1.61,-0.29),P=0.005〕with no significant effect on adverse events〔RR=1.00,95%CI(0.30,3.34),P>0.05〕.Conclusion The clinical effect of DD in adjuvant treatment of diabetic nephropathy is significant and has good safety.
作者
程丽颖
王梦玺
张翥
邵凤民
CHENG Liying;WANG Mengxi;ZHANG Zhu;SHAO Fengmin(Henan University of Chinese Medicine,Zhengzhou 450000,China;Nanjing University of Chinese Medicine,Nanjing 210029,China;Fuwai Central China Cardiovascular Hospital,Zhengzhou 451464,China)
出处
《中国全科医学》
CAS
北大核心
2021年第27期3477-3483,共7页
Chinese General Practice
基金
河南省医学科技攻关计划省部共建项目(SBGJ2018062)。
关键词
糖尿病肾病
当归补血汤
治疗结果
META分析
Diabetic nephropathies
Danggui Buxue decoction
Treatment outcome
Meta-analysis
