摘要
目的运用网状Meta分析方法,以单纯ACEI/ARB(angiotensin receptor blockers,ARB;angiotensin-converting enzyme inhibitor,ACE)治疗为共同参照,对比海昆肾喜胶囊、黄葵胶囊、尿毒清颗粒、肾衰宁胶囊、雷公藤多苷片、金水宝胶囊、百令胶囊、火把花根片对糖尿病肾病的临床疗效。方法计算机检索有关海昆肾喜胶囊、黄葵胶囊,尿毒清颗粒、肾衰宁胶囊、雷公藤多苷片、金水宝胶囊、百令胶囊、火把花根片联合ACEI/ARB治疗糖尿病肾病的随机对照试验。由2名研究人员独立筛选,包括质量、评估,数据采用R、Gemtc、RevMan 5.3软件进行网状Meta分析和传统Meta分析。最终纳入86篇RCTs,共7413例患者,涉及9种干预措施。结果Meta分析结果显示:①在综合疗效方面,金水宝胶囊、雷公藤多苷片、肾衰宁胶囊联合ACEI/ARB排序靠前,其中雷公藤多苷片联合ACEI/ARB降低24 h尿蛋白(24 h UPQ)和尿微量蛋白(UAER)的疗效最佳,肾衰宁胶囊联合ACEI/ARB降低血肌酐(Scr)、糖化血红蛋白(HBA1C)和空腹血糖(FPG)的疗效最佳;②在安全性方面,联合中成药均较单纯ACEI/ARB治疗有一定改善,因临床异质性较大无法定量合并,所有纳入研究未发生严重不良反应。由于纳入文献质量相对偏低,得出的结论尚有待临床验证。结论结合网状Meta分析结果和文献信息,在治疗有效率方面,金水宝胶囊联合ACEI/ARB疗效最优;在降低24 h尿蛋白(24 hUPQ)和尿微量蛋白(UAER)方面,均为雷公藤多苷片联合ACEI/ARB疗效最优;在降低血肌酐(Scr)、糖化血红蛋白(HBA1C)和空腹血糖(FPG)方面,均为肾衰宁胶囊联合ACEI/ARB疗效最优。
Objective The clinical effects of Haikun Shenxi capsule,Huangkui capsule,Niaoduqing granule,Shenshuaining capsule,Tripterygium wilfordii polyglycoside tablet,Jinshuibao capsule,bailing capsule and Huobaogen tablet on diabetic nephropathy were compared with simple ACEI/ARB(angiotensin receptor blockers,ARB;angiotensinconverting enzyme inhibitor,ACE)treatment by using the method of network Meta-analysis.Methods We searched the randomized controlled trials of Haikun Shenxi capsule,Huangkui capsule,Niaoduqing granule,Shenshuaining capsule,Tripterygium wilfordii polyglycoside tablet,Jinshuibao capsule,bailing capsule,Huobahuagen tablet combined with ACEI/ARB in the treatment of diabetic nephropathy.The data were screened independently by two researchers,including quality and evaluation,and the data were analyzed by R,Gemtc and RevMan5.3 software for reticular Meta analysis and traditional Meta analysis.Finally,a total of 7413 patients with 86 articles of RCTs,were included,involving9 kinds of intervention.Results The results of Meta analysis showed that:(1)In terms of comprehensive curative effect,Jinshuibao capsule,Tripterygium wilfordii polyglycosides tablets and Shenshuaining capsules combined with ACEI/ARB ranked first,among which Tripterygium wilfordii polyglycosides tablets combined with ACEI/ARB had the best effect on reducing 24 h urinary protein(24 hUPQ)and urinary microprotein(UAER),while Shenshuaining capsule combined with ACEI/ARB had the best effect on reducing serum creatinine(Scr),glycosylated hemoglobin(HBA1C)and fasting blood glucose(FPG).(2)In terms of safety,the combination of proprietary Chinese medicine was better than that of ACEI/ARB alone,which could not be quantitatively combined because of the large clinical heterogeneity,and there were no serious adverse reactions in all the studies.Due to the relatively low quality of the included literature,the conclusions still need to be verified by clinical practice.Conclusions Combined with the results of reticular meta-analysis and literature information,the effect of Jinshuibao capsule combined with ACEI/ARB is the best in terms of treatment efficiency;Tripterygium wilfordii polyglycoside tablet combined with ACEI/ARB has the best effect in reducing 24 h urinary protein(24 h UPQ)and urinary microprotein(UAER);In terms of reducing serum creatinine(Scr),glycosylated hemoglobin(HBA1C)and fasting blood glucose(FPG),Shenshuanning capsule combined with ACEI/ARB has the best effect.
作者
付彤飞
袁军
楼妍
吴健
阮冬冬
Fu Tongfei;Yuan Jun;Lou Yan;Wu Jian;Ruan Dongdong(Hubei University of Traditional Chinese Medicine,Clinical College of Traditional Chinese Medicine,Wuhan 430060,China;Wuhan Puren Hospital,Wuhan 430081,China;Hubei Provincial Hospital of Traditional Chinese Medicine,Wuhan 430061,China;Hubei Institute of Nephropathy,Hubei Institute of Traditional Chinese Medicine,Wuhan 430060,China)
出处
《世界科学技术-中医药现代化》
CSCD
北大核心
2022年第8期3105-3120,共16页
Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology
基金
国家自然科学基金委员会面上项目(82074364):基于Klotho/TRPC6/CatL通路研究特发性膜性肾病足细胞骨架损伤机制及中药的干预作用,负责人:袁军
武汉市科学技术局知识创新专项基础研究项目(2022020801020506):基于RhoA/ROCK激酶途径调控线粒体功能探讨特发性膜性肾病足细胞骨架损伤机制及中医干预的影响,负责人:袁军
湖北省卫生健康委员会西医科研面上项目(WJ2021M180):基于Klotho/TRPC6/CatL通路研究特发性膜性肾病足细胞骨架损伤机制,负责人:袁军
作者简介
通讯作者:袁军,教授,主任医师,医学博士,硕士研究生导师,主要研究方向:中医药防治肾脏疾病。
