黄芪注射液联合前列地尔治疗糖尿病肾病的Meta分析

Meta Analysis on Treating Diabetic Nephropathy with Huangqi Injection Combined with Alprostadil

目的:系统评价前列地尔联合黄芪注射液治疗糖尿病肾病的有效性。方法:通过Pubmed、Embase、中国生物医学文献数据库(CBM)、中国知网(CNKI)数据库、维普数据库检索有关前列地尔联合黄芪注射液治疗糖尿病肾病的文献。检索年限限定2005年1月~2017年6月。根据Revman5.3.1上的偏倚风险评估方法对纳入随机对照试验进行质量评估,使用Revman5.3.1软件做Meta分析。结果:经筛选最终纳入11篇相关文献。Meta分析结果显示:前列地尔联合黄芪注射液治疗糖尿病肾病,在降低24小时尿蛋白定量[MD=-0.32,95%CI(-0.55,-0.08)P=0.005]、24小时尿白蛋白排泄率[短疗程:MD=-1.15,95%CI(-1.63,-0.67),P<0.00001;长疗程:MD=-2.21,95%CI(-4.12,-0.30)P=0.02]、血肌酐[短疗程:MD=-8.77,95%CI(-12.58,-4.97),P<0.00001;长疗程:MD=-14.81,95%CI(-23.01,-6.61)P=0.0004]、尿素氮[MD=-1.34,95%CI(-1.63,-1.06),P<0.00001],升高血白蛋白[MD=3.62,95%CI(2.45,4.79),P<0.00001]方面优于单用前列地尔或黄芪注射液(P<0.05)。结论:前列地尔联合黄芪注射液可降低患者尿蛋白,保护肾功能。因纳入研究的数目不多、质量不高,仍需开展更多高质量、大样本的RCT对以上结论加以验证。

Objective： To systematically evaluate the efficacy of treating diabetic nephropathy with alprostadil combined with Huangqi injection. Methods： Pubmed,Embase,CBM,CNKI and VIP were retrieved to find literatures on treating diabetic nephropathy with alprostadil combined with Huangqi injection. The retrived time was limited from January 2005 to June 2017. Quality assessment was conducted for inclusion in randomized controlled trials according to the bias risk assessment method on Revman5. 3. 1,and Meta analysis was conducted using Revman5. 3. 1 software. Results： 11 related randomized controlled trials were included in this study.Meta analysis showed： treating diabetic nephropathy with alprostadil and Huangqi injection had good effect than that of using alprostadil or Huangqi injection only in reducing 24 hours urinary protein quantitative[MD =-0.32,95% CI（-0. 55,-0. 08） P = 0. 005],24 hours urinary albumin excretion rate（ 24-uaer） [short course：MD =-1. 15,95% CI（-1. 63,-0. 67） P〈0. 00001; long course： MD =-2. 21,95% CI（-4. 12,-0.30） P = 0. 02 ],serum creatinine（ Scr） [short course： MD =-8. 77,95% CI（-12. 58,-4. 97） P〈0.00001; long course： MD =-14. 81,95% CI（-23. 01,-6. 61） P = 0. 0004 ],blood urca nitrogen（ BUN）[MD =-1. 34,95% CI（-1. 63,-1. 06） P〈0. 00001],elevated blood albumin（ ALB） [MD = 3. 62,95% CI（ 2. 45,4. 79） P〈0. 00001 ]（ P〈0. 05）. Conclusion： Combined alprostadil with Huangqi injection can reduce urinary protein and protect renal function. However,the number of studies is small and the quality is not high enough,so it is necessary to carry out more high-quality and large sample RCT to verify the above conclusions.