目的:采用文献荟萃分析法(Meta)评估参苓白术散对糖尿病型肥胖的治疗作用,再结合网络药理学和动物实验方法分析参苓白术散治疗糖尿病肥胖的作用机制。方法:纳入国内外相关文献,以身体质量指数(BMI)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2...目的:采用文献荟萃分析法(Meta)评估参苓白术散对糖尿病型肥胖的治疗作用,再结合网络药理学和动物实验方法分析参苓白术散治疗糖尿病肥胖的作用机制。方法:纳入国内外相关文献,以身体质量指数(BMI)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h PG)、空腹血糖(FBG)、胰岛素抵抗指数(Homa-IR)、腰臀比作为结局指标,评估参苓白术散对糖尿病型肥胖的治疗作用。从GEO数据库中下载糖尿病肥胖的相关基因,在中药系统药理学数据库与分析平台(TCMSP)、中医药综合数据库(TCMID)和中药分子机制生物信息学分析工具(BATMAN-TCM)中下载参苓白术散的作用靶点,对两者的交集靶点进行蛋白质-蛋白质相互作用分析,再根据拓扑分析筛选出核心靶点蛋白质;制备糖尿病肥胖小鼠的模型,分组后进行参苓白术散的灌胃治疗,2周后测量各组小鼠体质量、血糖、Lee's指数,采用苏木精-伊红(HE)染色法分析各组小鼠的脂肪细胞体积变化,测量小鼠血清中的胆固醇、三酰甘油及核心靶点蛋白质的浓度。结果:共纳入9篇文献,数据完整,未发现发表偏倚,评估为low risk。患者服用参苓白术散后,BMI、HbA1c、2 h PG、Homa-IR和腰臀比均得到明显改善;参苓白术散-糖尿病肥胖的交集靶点共59个,核心靶点为载脂蛋白E(APO-E)、胰岛素生长因子-1(IGF-1)、纤溶酶原激活物抑制物-1(PAI-1),参苓白术散主要通过影响细胞对油酸的反应(GO:0071400)、转化生长因子β1生产的正调控(GO:0032914)和纤溶酶原激活的负调控(GO:0010757)等生物学功能,影响不饱和脂肪酸的生物合成(hsa01040)、脂肪酸代谢(hsa01212)等信号通路来治疗糖尿病肥胖;动物实验结果表明,经过参苓白术散灌胃治疗后的小鼠血糖变化不显著,体质量和Lee's指数呈现明显下降趋势,脂肪细胞直径明显缩小,胆固醇、三酰甘油浓度及APO-E、IGF-1、PAI-1水平均呈现下调趋势。结论:结合Meta分析和动物实验的结果,参苓白术散对糖尿病肥胖具有明显的治疗作用,其作用机制可能与影响不饱和脂肪酸、脂肪酸的合成,减少糖和脂肪的转化,纠正机体能量代谢失衡,调控自噬促进脂肪组织的分解有关。展开更多
Objective To assess the efficacy and safety of Yiqi Yangyin Huoxue therapy (YYHT) for the treatment of IgA nephropathy. Methods Databases articles about YYHT in treating IgAN patients were searched through February 20...Objective To assess the efficacy and safety of Yiqi Yangyin Huoxue therapy (YYHT) for the treatment of IgA nephropathy. Methods Databases articles about YYHT in treating IgAN patients were searched through February 2018. Comparisons were YYHT alone or YYHT in combination with western medicine as experimental intervention, and western medicine as the control. Randomized controlled trials (RCTs) were selected. Cochrane collaboration tool was used for assessing risk of bias to evaluate methodologies. RevMan 5.3 software was applied to analyze the data of included trials. Results A total of 21 studies involving 1473 patients were included. Meta-analysis results demonstrated that YYHT alone or YYHT in combination with western medicine were more efficacious than only western medicine in decreasing proteinuria [MD =-0.41, 95% CI (-0.53,-0.29), P < 0.00001] and the urine red blood cells [MD =-7.46, 95% CI (-9.28,-5.64), P < 0.00001]. There also showed improvement in the clinical total effective rate [OR = 2.78, 95% CI (2.14, 3.61), P < 0.00001] between the two groups. Some of the included trials did not report the adverse events. Conclusions Current evidence shows that YYHT can reduce proteinuria and urine red blood cells and improve the total efficacy rate. Since poor quality and publication bias of some included trials, more evidence-based medicine studies needed to define the role of YYHT in the treatment of IgAN.展开更多
文摘目的:采用文献荟萃分析法(Meta)评估参苓白术散对糖尿病型肥胖的治疗作用,再结合网络药理学和动物实验方法分析参苓白术散治疗糖尿病肥胖的作用机制。方法:纳入国内外相关文献,以身体质量指数(BMI)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h PG)、空腹血糖(FBG)、胰岛素抵抗指数(Homa-IR)、腰臀比作为结局指标,评估参苓白术散对糖尿病型肥胖的治疗作用。从GEO数据库中下载糖尿病肥胖的相关基因,在中药系统药理学数据库与分析平台(TCMSP)、中医药综合数据库(TCMID)和中药分子机制生物信息学分析工具(BATMAN-TCM)中下载参苓白术散的作用靶点,对两者的交集靶点进行蛋白质-蛋白质相互作用分析,再根据拓扑分析筛选出核心靶点蛋白质;制备糖尿病肥胖小鼠的模型,分组后进行参苓白术散的灌胃治疗,2周后测量各组小鼠体质量、血糖、Lee's指数,采用苏木精-伊红(HE)染色法分析各组小鼠的脂肪细胞体积变化,测量小鼠血清中的胆固醇、三酰甘油及核心靶点蛋白质的浓度。结果:共纳入9篇文献,数据完整,未发现发表偏倚,评估为low risk。患者服用参苓白术散后,BMI、HbA1c、2 h PG、Homa-IR和腰臀比均得到明显改善;参苓白术散-糖尿病肥胖的交集靶点共59个,核心靶点为载脂蛋白E(APO-E)、胰岛素生长因子-1(IGF-1)、纤溶酶原激活物抑制物-1(PAI-1),参苓白术散主要通过影响细胞对油酸的反应(GO:0071400)、转化生长因子β1生产的正调控(GO:0032914)和纤溶酶原激活的负调控(GO:0010757)等生物学功能,影响不饱和脂肪酸的生物合成(hsa01040)、脂肪酸代谢(hsa01212)等信号通路来治疗糖尿病肥胖;动物实验结果表明,经过参苓白术散灌胃治疗后的小鼠血糖变化不显著,体质量和Lee's指数呈现明显下降趋势,脂肪细胞直径明显缩小,胆固醇、三酰甘油浓度及APO-E、IGF-1、PAI-1水平均呈现下调趋势。结论:结合Meta分析和动物实验的结果,参苓白术散对糖尿病肥胖具有明显的治疗作用,其作用机制可能与影响不饱和脂肪酸、脂肪酸的合成,减少糖和脂肪的转化,纠正机体能量代谢失衡,调控自噬促进脂肪组织的分解有关。
文摘Objective To assess the efficacy and safety of Yiqi Yangyin Huoxue therapy (YYHT) for the treatment of IgA nephropathy. Methods Databases articles about YYHT in treating IgAN patients were searched through February 2018. Comparisons were YYHT alone or YYHT in combination with western medicine as experimental intervention, and western medicine as the control. Randomized controlled trials (RCTs) were selected. Cochrane collaboration tool was used for assessing risk of bias to evaluate methodologies. RevMan 5.3 software was applied to analyze the data of included trials. Results A total of 21 studies involving 1473 patients were included. Meta-analysis results demonstrated that YYHT alone or YYHT in combination with western medicine were more efficacious than only western medicine in decreasing proteinuria [MD =-0.41, 95% CI (-0.53,-0.29), P < 0.00001] and the urine red blood cells [MD =-7.46, 95% CI (-9.28,-5.64), P < 0.00001]. There also showed improvement in the clinical total effective rate [OR = 2.78, 95% CI (2.14, 3.61), P < 0.00001] between the two groups. Some of the included trials did not report the adverse events. Conclusions Current evidence shows that YYHT can reduce proteinuria and urine red blood cells and improve the total efficacy rate. Since poor quality and publication bias of some included trials, more evidence-based medicine studies needed to define the role of YYHT in the treatment of IgAN.
