桃核承气汤辅助治疗糖尿病肾病临床疗效的Meta分析

A Meta-analysis of the clinical efficacy of the Taohe Chengqi decoction on diabetes nephropathy

目的:系统分析桃核承气汤在糖尿病肾病辅助治疗中所发挥的作用。方法:计算机检索中国知网、维普网等数据库自建库以来至2021年11月公开发表的桃核承气汤辅助治疗糖尿病肾病的临床随机对照试验文献。其中对照组采用西医常规治疗,试验组在对照组基础上配合桃核承气汤加减。采用Cochrane风险偏倚评估工具评价文献质量。采用RevMan 5.4软件进行统计学分析。结果:本研究共纳入文献7篇,包含患者812例。结果显示,试验组总有效率高于对照组(P=0.002),24 h尿蛋白定量、尿白蛋白排泄率、血肌酐低于对照组(均P<0.00001)。桃核承气汤能在西医基础治疗上进一步提高总有效率,降低24 h尿蛋白定量、血肌酐及尿白蛋白排泄率水平。本研究纳入患者总量较大,且研究均为随机对照试验,虽然结果存在一定的异质性,但通过严谨的敏感性分析、亚组分析,使可信度增加。结论:本研究从中西医结合的角度分析桃核承气汤泄热逐瘀功效与抗凝、抗炎,抗纤维化,延缓糖尿病肾病进展的作用,给临床实践中合理应用桃核承气汤辅助治疗糖尿病肾病提供强有力的数据支撑,但安全性仍需要更多研究论证。

Objective:To systematically analyze the role of the Taohe Chengqi decoction(桃核承气汤)on diabetes nephropathy.Methods:The clinical randomized controlled trials of treating diabetes nephropathy with the Taohe Chengqi decoction published from the establishment of the database to November 2021 was searched in the databases such as CNKI,VIP and so on.In each included study,the control group was treated by conventional Western medicine method,while the test group was treated with the Taohe Chengqi decoction additionally.Cochrane risk bias assessment tool was used to evaluate the quality of the included literature.RevMan 5.4 software was used for a statistical analysis.Results:A total of 7 studies with 812 cases were included finally.The results showed that the total efficiency in the test group was higher than that the control group(P=0.002),and that the 24-hour urine protein quantity,urinary albumin excretion rate,and serum creatinine in the test group were lower than those in the control group(all P<0.00001).The Taohe Chengqi decoction can further improve the overall effective rate in the basic treatment of Western medicine,and reduce the quantitative urine protein,blood creatinine and urinary albumin excretion rate in 24 hours.The total number of patients included in this study is large,and the studies are all randomized controlled trials,although there is some heterogeneity in the results,but through rigorous sensitivity analysis and subgroup analysis,the confidence is increased.Conclusion:This study analyzes the effect of the Taohe Chengqi decoction in heat release and stasis and anticoagulation,anti-inflammatory,anti-fibrosis,and delays the progression of diabetic nephropathy from the perspective of the integrated medicine,which provides strong data support for the rational application of the Taohe Chengqi decoction in the treatment of diabetic nephropathy,but more research and demonstration are still needed on its safety.