中西医结合治疗糖尿病合并高血压有效性和安全性的Meta分析

Meta Analysis of the Efficacy and Safety of Integrated Traditional Chinese and Western Medicine in the Treatment of Diabetes with Hypertension

目的:系统评价中西医结合治疗糖尿病合并高血压的有效性和安全性。方法:检索中国知网(CNKI)、万方数据(WAN-FANG DATA)、维普中文科技期刊数据库(VIP)、中国生物医学文献服务系统(SinoMed)、Web of Science、PubMed、Embase与Cochrane Library 8个数据库,筛选中西医结合治疗糖尿病合并高血压的随机对照试验研究并提取数据。采用Cochrane偏倚风险评估工具对文献方法学进行质量评价,采用Review Manager 5.4软件进行Meta分析。结果:最终纳入24篇文献,包含4206例患者,其中干预组2103例,对照组2103例。Meta分析结果显示,中西医结合治疗在提高糖尿病合并高血压患者的临床总有效率[OR=5.82,95%CI(3.69,9.17),P<0.00001],降低收缩压[MD=-11.78,95%CI(-14.88,-8.68),P<0.00001]、舒张压[MD=-8.13,95%CI(-9.52,-6.73),P<0.00001]、空腹血糖[MD=-0.72,95%CI(-0.99,-0.45),P<0.00001]、餐后两小时血糖[MD=-0.88,95%CI(-1.29,-0.47),P<0.00001]、糖化血红蛋白[MD=-0.73,95%CI(-0.88,-0.57),P<0.00001]、甘油三酯[MD=-0.16,95%CI(-0.28,-0.04),P=0.008]、总胆固醇[MD=-0.44,95%CI(-0.63,-0.26),P<0.00001]、中医证候积分[MD=-6.10,95%CI(-7.04,-5.17),P<0.00001]、不良反应发生率[MD=0.40,95%CI(0.25,0.63),P<0.0001]方面优于对照组。结论:中医药对糖尿病合并高血压患者有较好的疗效与安全性。但目前研究的样本量较小,缺乏明确辨证的研究,且文献的证据等级较低,所得结论仍需要更多大样本、多中心、高质量的临床研究加以论证。

Objective To systematically evaluate the efficacy and safety of integrated traditional Chinese and western medicine in the treatment of diabetes with hypertension.Methods Eight databases including CNKI,WAN-FANG DATA,VIP,SinoMed,Web of Science,PubMed,Embase and Cochrane Library were searched to screen the randomized controlled trial of the combination of traditional Chinese and western medicine in the treatment of diabetes with hypertension and extract the data.Cochrane bias risk assessment tool was used to evaluate the quality of literature methodology,and Review Manager 5.4 software was used for meta analysis.Results 24 articles were included,including 4206 patients,2103 in the intervention group and 2103 in the control group.Meta analysis results show that the integrated treatment of traditional Chinese and western medicine can improve the clinical total effective rate of diabetes patients with hypertension[OR=5.82,95%CI(3.69,9.17),P<0.0001],reduce systolic blood pressure[MD=-11.78,95%CI(-14.88,-8.68),P<0.0001],diastolic blood pressure[MD=-8.13,95%CI(-9.52,-6.73),P<0.0001],fasting blood glucose[MD=-0.72,95%CI(-0.99,-0.45),P<0.0001]Two hour postprandial blood glucose[MD=-0.88,95%CI(-1.29,-0.47),P<0.00001],glycosylated hemoglobin[MD=-0.73,95%CI(-0.88,-0.57),P<0.00001],triglyceride[MD=-0.16,95%CI(-0.28,-0.04),P=0.008],total cholesterol[MD=-0.44,95%CI(-0.63,-0.26),P<0.00001],TCM syndrome score[MD=-6.10,95%CI(-7.04,-5.17),P<0.00001]The incidence of adverse reactions[MD=0.40,95%CI(0.25,0.63),P<0.0001]was superior to the control group.Conclusion Traditional Chinese medicine is effective and safe in treating diabetes patients with hypertension.However,the sample size of the current study is small,there is a lack of clear syndrome differentiation research,and the level of evidence in the literature is low.The conclusions still need more large sample,multi center,high-quality clinical research to demonstrate.