当归补血汤加减联合ACEI/ARB类药物治疗Ⅲ期和Ⅳ期糖尿病肾病的Meta分析

Meta-analysis of DangguiBuxue decoction combined with ACEI/ARB drugs in the treatment of stage Ⅲ and Ⅳ diabetic nephropathy

目的系统评价当归补血汤加减联合血管紧张素转化酶抑制剂或血管紧张素受体阻滞剂(angiotension converting enzyme inhibitors/angiotensin receptor blocker,ACEI/ARB)治疗Ⅲ期和Ⅳ期糖尿病肾病(diabetic nephropathy,DN)疗效及安全性。方法检索知网、万方、维普、医学文献检索服务系统等数据库并结合手工检索,全面收集当归补血汤加减联合ACEI/ARB治疗Ⅲ期和Ⅳ期DN临床随机对照试验(randomized controlled trial,RCT)。对符合标准的文献采用RevMan5.3软件进行Meta分析。结果 Meta分析显示:当归补血汤加减联合ACEI/ARB治疗Ⅲ期和Ⅳ期DN在提高临床总有效率(OR=4.09,95%CI [2.56~6.52],P<0.05)、降低血肌酐(MD=-9.69, 95%CI [-16.8~-2.58],P<0.05)、尿素氮(MD=-1.37, 95%CI [-1.89~-0.84], P<0.05)和24 h尿蛋白定量(SMD=-2.2,95%CI [-3.35~-1.04],P<0.05)方面高于对照组,但在降低HbA1c水平方面(MD=-0.52,95%CI [-1.31~0.28],P>0.05)与对照组相当。结论当归补血汤加减联合ACEI/ARB较单用ACEI/ARB对Ⅲ和IV的DN具有更好的疗效。

Objective To evaluate the efficacy and safety of DangguiBuxuedecoction combined with angiotensin converting enzyme inhibitor or angiotensin receptor blocker(ACEI/ARB) in the treatment of stage Ⅲ and Ⅳ diabetic nephropathy(DN).Methods The randomized controlled trials(RCTs) of DangguiBuxue decoction combined with ACEI/ARB in the treatment of stage Ⅲ and Ⅳ DN were comprehensively collected by searching databases such as CNKI,Wanfang,VIP and Medical Literature Retrieval Service System and combining with manual search.Rev man 5.3 software was used for Meta-analysis.Results Meta-analysis showed that:DangguiBuxue decoction combined with ACEI/ARB in the treatment of stage Ⅲ and Ⅳ DN increased the clinical total effective rate(OR=4.09,95%CI [2.56-6.52],P<0.05),decreased serum creatinine(MD=-9.69,95%CI[-16.8~-2.58],P<0.05),urea nitrogen(MD=-1.37,95%CI[-1.89~-0.84],P<0.05) and 24 h urinary protein quantification(SMD=-2.2,95% CI [-3.35~-1.04],P<0.05).The level of HbA1 c(MD=-0.52,95%CI [-1.31-0.28],P>0.05) was similar to that of the control group.Conclusion DangguiBuxue decoction combined with ACEI/ARB has better curative effect on DN Ⅲand Ⅳ than ACEI/ARB alone.