摘要
Objective： This meta- analysis evaluated the efficacy and safety of Chinese herbal medicine （CHM） combined withangiotensin-converting enzyme inhibitors （ACEIs） and/or angiotensin-receptor blockers （ARBs）for treatment ofincipient diabetic nephropathy（IDN）. Methods： Nine data bases were searched for randomized controlled trials ofChinese herbal medicine（CHM） and ACEI/ARB for treatment of IDN. Included articles were published betweenJanuary2006 and December 2016. All studies were divided into prescriptions containing both Astragali Radix andRehmanniae Radix （i subgroup）, Astragali Radix（Huangqi） or Rehmanniae Radix（Dihuang） （ii subgroup）, neitherAstragali Radix nor Rehmanniae Radix （iii subgroup）. Review Manager 5.3 was used for subgroup analysis.Results： In total, 28 RCTs with 2017 patients were included. The results showed 1）the urinary albumin excretionrate （UAER） can be reduced significantly using CHM with ACEI or ARB for treatment of IDN compared to ACEIor ARB alone, and reduction of the UAER of the i subgroup was superior to that of the other two subgroups;2）serum creatinine （Scr） levels can be reduced significantly using CHM combined with ACEI or ARB, andreduction of Scr in the ii subgroup was superior to that in the iii subgroup; 3）reduction of BUN in group A was notbetter than that in group B. Conclusion： In summary, CHMs combined with ACEI/ARB can decrease UAER andScr significantly compared to the use of ACEI/ARB during IDN treatment. The effect was more significant in theCHM group containing Astragali Radix or Rehmanniae Radix. The application of Astragali Radix and RehmanniaeRadix should be emphasized in third stage diabetic nephropathy.
目的：本研究评估中草药联合血管紧张素转换酶抑制剂（ACEIs）和/或血管紧张素受体阻滞剂（ARBs）治疗糖尿病肾病（IDN）的有效性和安全性.方法：在9个数据库中搜索中药（CHM）和ACEI/ARB治疗IDN的随机对照试验.纳入的文章发表于2006年1月至2016年12月.所有研究分为含黄芪和生地黄（i亚组）,含黄芪或生地黄（地黄）（ii亚组）,不含黄芪和地黄（iii亚组）.Review Manager5.3用于亚组分析.结果：最终纳入28个随机对照试验,共2017个患者.Meta分析结果显示：1）CHM联合ACEI/ARB治疗IDN与单用ACEI/ARB相比,尿白蛋白排泄率（UAER）显著降低,且i亚组降低UAER的效果优于另外2个亚组;2）CHM联合ACEI/ARB治疗IDN与单用ACEI/ARB相比,可显着降低血清肌酐（Scr）水平,且ii亚组降低Scr的效果优于iii亚组;3）CHM联合ACEI/ARB治疗IDN与单用ACEI/ARB相比,在降低BUN方面无统计学差异.结论：与单独应用ACEI/ARB相比,CHMs联合ACEI/ARB可显着降低UAER和Scr水平,且含黄芪或地黄的CHM亚组效果更为显著.故早期糖尿病肾病的治疗采用中草药联合ACEI/ARB是更为有效的治疗方法,同时应重视黄芪和地黄的应用.
