益气解毒活血中药治疗糖尿病肾病的Meta分析

Meta-analysis on Chinese Medicine for Benefiting Qi and Resolving Toxin and Activating Blood Circulation in Treatment of Diabetic Nephropathy

目的:系统的评价益气解毒活血中药治疗糖尿病肾病的有效性、安全性。方法:计算机检索2002—2012年维普中文科技期刊全文数据库、中华生物文献数据库、万方中华生物医学会数字化期刊及万方数字化期刊全文数据库,同时辅以人工检索,收集西药联合益气解毒活血中药对比单用西药类药物或单用益气解毒活血中药对比单用西药治疗DN的随机对照实验(RCT)和半随机对照实验。由两位研究者独立评估纳入文献的方法学质量,采用Cochrane协作组提供的Revman5.2软件对16篇RCT文献进行Meta分析。结果:共纳入16篇中文RCT论文,1篇被评为B级,余均被评为C级。Meta分析结果显示:西药基础上联合益气解毒活血中药治疗临床DN尿微量白蛋白排泄率(UAER)(P=0.001)、血肌酐(Cr)(P<0.000 01)、尿素氮(BUN)(P<0.000 1)、糖化血红蛋白(Hb A1c)(P=0.04)疗效优于单独应用西药组;益气解毒活血中药降低尿微量白蛋白排泄率(UAER)(P=0.02)、肌酐(Cr)(P=0.03)的作用优于ACEI或ARB类药物,降低糖化血红蛋白(Hb A1c)(P=0.28)的作用可能相似于ACEI或ARB类药物。益气解毒活血中药治疗DN的总体疗效得以肯定,为指导今后的临床用药提供理论依据。漏斗图显示不对称,可能与临床试验设计和发表偏倚有关。结论:益气解毒活血中药治疗DN是一种有效的方法。

Objective： To evaluate the effectiveness security of benefiting Qi and resolving and activating blood traditional Chinese medicine treatment of diabetic nephropathy. Methods： During 2002-2012,Weipu Chinese Technology Journal Full-text Database,China Biological Literature Database,Wanfang Chinese Journal of Biomedical Digitize Journal and Wanfang Digitize Full-text Database were used to collect DN RCTs and half RCTs by manual searching. We compared the efficacy of Western medicine combined with TCM and the Western medicine alone. The two researchers independently assessed the methodological quality of the included studies by using Cochrane＇s Revman 5. 2 soft ware to analyze16 RCT literature. Result： One of 16 RCT literature was B level and the other 15 were C level. Meta-analysis indicated when Western medicine combined with TCM treating DN,the clinical urinary albumin excretion rate（ UAER）（ P =0. 001）,Cr（ P〈 0. 000 01）,BUN（ P〈 0. 000 1）,Hb A1c（ P = 0. 04） were better than those of the other treatment. TMC for benefiting Qi and resolving and activating blood has definite efficacy on treating DN. It can provide a theoretical basis for the clinical treatment. Funnel plot asymmetry displayed it may be related to the clinical trial design and publication bias. Conclusion： Benefiting Qi and resolving and activating blood traditional Chinese medicine is an effective method for treating DN.