黄芪中药制剂治疗糖尿病心肌病疗效的系统评价和Meta分析

A Systematic Review and Meta-analysis of Radix Astragali seu Hedysari Medicament for Diabetic Cardiomyopathy

目的:系统评价黄芪中药制剂治疗糖尿病心肌病的临床疗效和安全性。方法:通过计算机检索中国知网、万方、重庆维普全文数据库及PubMed数据库,收集黄芪中药制剂治疗糖尿病心肌病的随机对照试验(RCT),根据纳入、排除标准和质量评价筛选文献,采用Review Manager 5.3软件对提取的数据进行Meta分析。结果:最终纳入30项研究,纳入研究的病例数为2951人。Meta分析结果显示:与对照组比较,观察组包含黄芪中药制剂的方案干预糖尿病心肌病患者的临床疗效[OR=3.41,95%CI(2.61,4.45)]、左室射血分数[MD=-6.68,95%CI(5.78,8.37)],E/A比值[MD=0.12,95%CI(0.07,0.17)],空腹血糖[MD=-1.06,95%CI(-1.42,-0.70)],餐后2 h血糖[MD=-1.31,95%CI(-1.82,-0.79)],糖化血红蛋白[MD=-0.97,95%CI(-1.45,-0.48)],血胆固醇[MD=-0.73,95%CI(-1.16,-0.29)],三酰甘油[MD=-1.31,95%CI(-2.15,-0.47)],高密度脂蛋白[MD=0.41,95%CI(0.13,0.70)],低密度脂蛋白[MD=-0.65,95%CI(-0.98,-0.32)],差异均有统计学意义,而且黄芪中药制剂不良反应较少[OR=0.23,95%CI(0.10,0.55)]。结论:与单用西药治疗比较,西药联合黄芪中药制剂在改善糖尿病心肌病患者的临床症状、降糖、调脂、提高心功能方面更有优势,同时不良反应较少。鉴于纳入研究的质量较低,上述结论尚需要更多高质量的随机研究加以证实。

Objective:To systematically evaluate the clinical effects and safety of Radix Astragali seu Hedysari medication in treatment of diabetic cardiomyopathy.Methods:Randomized controlled trials on Radix Astragali seu Hedysari medication treating diabetic cardiomyopathy were collected from CNKI,Wanfang,VIP and Pubmed database.We selected randomized controlled trials(RCT)of Radix Astragalus,a Chinese Medicine preparation in the treatment of diabetic cardiomyopathy.According to the inclusion,exclusion and quality evaluation,the literature was screened.Review Manager 5.3 software was used to for Meta analysis.Results:A total of 30 studies involving 2951 cases were included.Meta-analysis showed that compared with the control group,Radix Astragali seu Hedysari of Chinese medicine preparation scheme of the observation group to intervene patients with diabetic cardiomyopathy[OR=3.41,95%CI(2.61,4.45)],LVEF[MD=-6.68,95%CI(5.78,8.37)],E/A[MD=0.12,95%CI(0.07,0.17)],FBG[MD=-1.06,95%CI(-1.42,-0.70)],P2 hBG[MD=-1.31,95%CI(-1.82,-0.79)],HbA1c[MD=-0.97,95%CI(-1.45,-0.48)],TC[MD=-0.73,95%CI(-1.16,-0.29)],TG[MD=-1.31,95%CI(-2.15,-0.47)],HDL-C[MD=0.41,95%CI(0.13,0.70)],LDL-C[MD=-0.65,95%CI(-0.98,-0.32)],and the difference was statistically significant.There were less adverse events in Radix Astragali seu Hedysari medication group[OR=0.23,95%CI(0.10,0.55)].Conclusion:Compared with single Western medicine,Western medicine combined with Chinese medicine preparation of Radix Astragali seu Hedysari has more advantages in improving the clinical symptoms of patients with diabetic cardiomyopathy,lowering blood sugar,lowering lipids,and improving heart function,and has fewer adverse reactions.In view of the low quality of the included studies,the above conclusions still need more high-quality randomized studies to confirm.