中药灌肠治疗Ⅳ期糖尿病肾病系统评价

Systematic Evaluation of Chinese Herbal Enema for Treatment of Stage Ⅳ Diabetic Nephropathy

目的:系统评价中药灌肠治疗Ⅳ期糖尿病肾病的临床疗效及安全性。方法:检索万方数据库、中国知网、维普期刊数据库、Cochrane Library数据库、Embase数据库、PubMed数据库,收集中药灌肠治疗Ⅳ期糖尿病肾病的临床随机对照试验。由两名研究人员独自筛选文献,对纳入的研究进行资料采集,并使用RevMan5.3统计软件进行分析。结果:最后纳入8个研究,共869例Ⅳ期糖尿病肾病患者。Meta分析结果显示,加用中药灌肠法治疗Ⅳ期糖尿病肾病,在提高有效率[OR=4.95;95%CI(3.47,7.06),P<0.00001],降低患者24小时尿蛋白定量(24-hour urinary protein,24hUTP)[MD=-0.79;95%CI(-1.38,-0.21),P=0.008]、血肌酐(serum creatinine,Scr)[SMD=-1.26;95%CI(-1.93,-0.58),P=0.0003]、尿素氮(blood urea nitrogen,BUN)[MD=-1.20;95%CI(-2.18,-0.23),P=0.02]方面均显著优于对照组。结论:基于目前的数据评估,中药灌肠联合西医基础治疗Ⅳ期糖尿病肾病疗效显著,但此结论仍需要更多设计严谨、多中心参与,大样本量的高质量临床随机对照试验来进一步验证。

Objective:To systematically evaluate the clinical efficacy and safety of traditional Chinese medicine enema in the treatment of stageⅣdiabetic nephropathy.Methods:Search Wanfang database,CNKI,Weipu journal database,Cochrane Library database,Embase database,PubMed database,and collect clinical randomized controlled trials of traditional Chinese medicine enema treatment of stageⅣdiabetic nephropathy.Two researchers independently screened the literature,collected data from the included studies,and analyzed using RevMan5.3 statistical software.Results:Finally,8 studies were included,with a total of 869 patients with stageⅣdiabetic nephropathy.Meta-analysis results suggest that the addition of traditional Chinese medicine enema to the treatment of stageⅣdiabetic nephropathy improved the effective rate[OR=4.95;95%CI(3.47,7.06),P<0.00001],and decreased the patien′s 24-hour urinary protein(24 hUTP)[MD=-0.79;95%CI(-1.38,-0.21),P=0.008],serum creatinine(Scr)[SMD=-1.26;95%CI(-1.93,-0.58),P=0.0003],blood urea nitrogen(BUN)[MD=-1.20;95%CI(-2.18,-0.23),P=0.02]were significantly better than the those of the control group,respectively.Conclusion:Based on the current data evaluation,traditional Chinese medicine enema combined with Western medicine basic treatment of stageⅣdiabetic nephropathy has a significant effect,but this conclusion still needs more rigorous design,multi-center participation,and high-quality clinical randomized controlled trials with large samples for further verification.