复方血栓通胶囊联合血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂治疗早期糖尿病肾病疗效的系统评价

Meta-analysis of Efficacy of Compound Xueshuantong Capsules Combined with ACEI/ARB in Treatment of Diabetic Kidney Disease

目的:系统评价复方血栓通胶囊联合血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂(angiotensin-converting enzyme inhibitors,ACEI/angiotensin receptor blockers,ARB)治疗早期糖尿病肾病(diabetic kidney disease,DKD)的疗效。方法:计算机检索中国期刊全文数据库、万方数据库和维普数据库,数据库建库起至2016年5月3日期间,收集复方血栓通胶囊联合ACEI/ARB治疗早期DKD的随机对照试验(randomized controlled trial,RCT),同时辅以手工检索,评价纳入研究质量,合并结果进行Meta分析。结果:共纳入6项RCT,合计532例患者。Meta分析结果显示,观察组治疗后在提高临床总有效率(RR=1.33,95%CI=1.17~1.52,P<0.000 01),降低尿白蛋白排泄率(MD=-21.03,95%CI=-31.75^-10.31,P=0.000 1)、全血高切黏度(MD=-1.06,95%CI=-1.46^-0.65,P<0.000 01)、全血低切黏度(MD=-1.78,95%CI=-3.43^-0.12,P=0.04)、总胆固醇(MD=-0.98,95%CI=-1.67^-0.29,P=0.006)、三酰甘油(MD=-0.40,95%CI=-0.67^-0.13,P=0.004)和提高高密度脂蛋白胆固醇(MD=0.32,95%CI=0.10~0.55,P=0.005)等方面均优于对照组,差异有统计学意义;2组患者空腹血糖(MD=-0.34,95%CI=-1.14~0.45,P=0.40)、餐后2 h血糖(MD=-0.84,95%CI=-2.67~0.99,P=0.37)、糖化血红蛋白(MD=-0.02,95%CI=-0.19~0.15,P=0.37)、尿素氮(MD=-0.16,95%CI=-0.59~0.27,P=0.46)、血肌酐(MD=-9.19,95%CI=-8.72~3.55,P=0.16)和低密度脂蛋白胆固醇(MD=-0.60,95%CI=-1.58^-0.39,P<0.23)等方面比较,差异无统计学意义。结论:复方血栓通胶囊联合ACEI/ARB治疗早期糖尿病肾病的疗效优于单用ACEI/ARB。

OBJECTIVE：To systematically review the efficacy of compound Xueshuantong capsules combined with angiotensin-converting enzyme inhibitors（ ACEI）/angiotensin receptor blockers（ ARB） in treatment of diabetic kidney disease（ DKD） .METHODS： CJFD, VIP and Wanfang Database were retrieved to collect the randomized controlled trials（ RCT） about the efficacy of compound Xueshuantong Capsules combined with ACRI/ARB in treatment of DKD till May.3rd , 2016, manual retrieval was adopted.Quality evaluation and Meta-analysis of included literatures were conducted.RESULTS： A total of 6 RCTs were included, involving 532 cases.Results of Meta-analysis showed that compound Xueshuantong capsules combined with ACEI/ARB （ test group） was better than that of ACEI/ARB（ control group） in increasing clinical total effective rate（RR=1.33,95%CI=1.17-1.52,P〈0.000 01）, reducing UAER （ MD =-21.03 , 95%CI =-31.75--10.31 , P =0.000 1 ） , whole blood high-shear viscosity （ MD =-1.06 , 95%CI=-1.46--0.65,P〈0.000 01）, whole blood low-shear viscosity（MD=-1.78,95%CI=-3.43--0.12, P=0.04）, TC （MD =-0.98,95%CI =-1.67--0.29,P =0.006）, TG （MD =-0.40,95%CI =-0.67--0.13,P=0.004） and increasing HDL-C （MD=0.32,95%CI=0.10-0.55,P=0.005）, there were statistically significant differences between two groups.And there was no significant difference in the FBG （ MD =-0.34, 95%CI=-1.14-0.45,P =0.40）, PBG （MD =-0.84,95%CI =-2.67-0.99,P =0.37）, HbA1c （MD =-0.02,95%CI=-0.19-0.15,P=0.37）, BUN （MD=-0.16,95%CI=-0.59-0.27,P=0.46）, Scr （MD=-9.19,95%CI=-8.72-3.55,P=0.16） and LDL-C （MD=-0.60,95%CI=-1.58--0.39,P=0.23） between two groups.CONCLUSIONS： The efficacy of compound Xueshuantong capsules combined with ACEI/ARB is better than only ACEI/ARB in treatment of DKD.