益肾化湿颗粒联合ACEI/ARB治疗糖尿病肾脏疾病有效性的系统评价和Meta分析
A Meta Analysis of Yishen Huashi Granule Combining with ACEI/ARB in the Treatment of Diabetic Kidney Disease
姜玉华 1张泽钰 1郭敬 1张娉娜 1邱昱衡 1罗倩 1唐靖怡 1刘玉宁 2刘伟敬2
作者信息
- 1. 北京中医药大学东直门医院(北京 100700);北京中医药大学(北京 100029)
- 2. 北京中医药大学东直门医院(北京 100700)
- 折叠
摘要
目的:为系统评价益肾化湿颗粒联合血管紧张素转化酶抑制剂(ACEI)或者血管紧张素Ⅱ受体阻滞剂(ARB)治疗糖尿病肾脏疾病(DKD)的临床疗效.方法:该研究检索了七大医学数据库,包括PubMed、Embase、The Cochrane Library、CNKI、CBM、VIP和Wan Fang data,检索时间均从建库至2023 年11 月20 日,根据预先确定的纳排标准筛选益肾化湿颗粒联合ACEI/ARB治疗DKD的标准随机对照试验(RCT),并提取相关临床数据.随后采用"Cochrane风险评估工具"对所纳入文献进行质量评价,使用Revman 5.3 软件进行偏倚评估和绘图的meta分析.最终共纳入 13 篇RCT,涉及 1 049 例患者,其中实验组530 例,对照组519 例.结果:益肾化湿颗粒联合ACEI/ARB能提高DKD的总体有效率[RR=1.24,(95%CI:1.17,1.33),P<0.01],并且能够降低尿白蛋白排泄率(UAER)[MD=-23.29(95%CI:-26.93,-19.65),P<0.01]、24 h尿蛋白(24 h-UTP)[SMD=-0.31(95%CI:-0.52,-0.09),P<0.01]、血肌酐(Scr)[MD=-25.60(95%CI:-33.13,-18.07),P<0.01]和血尿素氮(BUN)[MD=-2.28(95%CI:-2.49,-2.07),P<0.01]等水平,同时在降低空腹血糖(FBG)水平[MD=-0.58(95%CI:-1.00,-0.17),P<0.01]和缓解不良反应方面上亦优于对照组.结论:益肾化湿颗粒联合ACEI/ARB治疗DKD患者相比于单独使用ACEI/ARB有较好的疗效和安全性,可充分发挥糖尿病患者肾脏保护作用.但鉴于本次纳入研究数量较少,质量较低,因此该结论需开展更大样本的高质量、双盲的RCT研究来予以验证.
Abstract
Objective:To systematically evaluate the clinical efficacy of Yishen Huashi granule combined with ACEI/ARB in the treatment of diabetic kidney disease(DKD).Methods:Seven medical databases including PubMed,Embase,The Cochrane Li-brary,CNKI,CBM,VIP and Wan Fang data,were retrieved from the database until November 20,2023.Standard randomized con-trolled trial(RCTS)of Yishen Huashi Granule for the treatment of DKD was screened according to the pre-determined admission cri-teria,and relevant data were extracted.Then,we used Cochrane bias risk assessment tool to evaluate the quality of the included liter-ature,and Revman5.3 software were used for bias assessment and meta-analysis.Ultimately,a total of 13 articles and 1049 cases were involved,including 530 in the experimental group and 519 in the control group.Results:The results showed that Yishen Huashi Granule combined with ACEI/ARB could improve the overall effective rate of DKD[RR1.24,(95%CI:1.17,1.33),P<0.01],and reduce the urinary albumin excretion rate(UAER)[MD=-23.29(95%CI:-26.93,-19.65),P<0.01],24 h-UTP[MD=-0.04(95%CI:-0.06,-0.01),P<0.01],Scr[MD=-25.60(95%CI:-33.13,-18.07),P<0.01],blood urea nitrogen(BUN)[MD=-2.28(95%CI:-2.49,-2.07),P<0.01],etc.And at the same time,it can reduce fasting blood glucose(FBG)MD=-0.58(95%CI:-1.00,-0.17),P<0.01]and alleviate adverse reactions.Conclusion:The existing evidence shows that Yishen Huashi Granule combined with ACEI/ARB has better efficacy and safety than ACEI/ARB alone in treating DKD pa-tients,which can give full renal protection of diabetic patients.However,in view of the low quality of included study,the conclusion still needs to be verified by a larger sample of high quality and double-blind RCT.
关键词
益肾化湿颗粒/ACEI/ARB/糖尿病肾脏疾病/系统评价/meta分析Key words
Yishen Huashi granule/ACEI/ARB/Diabetic kidney disease/Systematic reviews/Meta analysis引用本文复制引用
基金项目
国家自然科学基金资助项目(82074361)
出版年
2024
NETL
NSTL
万方数据