摘要
目的基于Meta分析法评价参芪地黄汤治疗气阴两虚型Ⅲ~Ⅳ期糖尿病肾病(DKD)的疗效及不良反应。方法检索中国知识基础设施工程(CNKI)、万方数据知识服务平台(WanFang)、重庆维普资讯有限公司(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Embase等数据库,收集建库至2021年11月关于参芪地黄汤治疗气阴两虚型Ⅲ~Ⅳ期DKD的随机对照试验,提取数据,使用ROB 2.0进行偏倚风险评估,采用RevMan 5.4软件进行Meta分析,对结局指标使用GRADE进行证据质量评价。结果共纳入13篇文献,合计患者962例。Meta分析结果显示,参芪地黄汤可改善中医证候积分[MD=-4.39,95%CI(-6.27,-2.51)]。根据不同分期进行亚组分析:①尿白蛋白排泄率(UAER):Ⅲ期[MD=-32.98,95%CI(-44.98,-20.97)],Ⅲ~Ⅳ期[MD=-70.72,95%CI(-91.60,-49.84)],治疗组均优于对照组;②24 h尿蛋白定量(24 hUTP):Ⅲ~Ⅳ期[SMD=-1.10,95%CI(-1.64,-0.56)],治疗组优于对照组,Ⅲ期[SMD=-0.28,95%CI(-0.65,0.08)]、Ⅳ期[SMD=-0.38,95%CI(-0.88,0.12)]优势并不明显;③空腹血糖(FPG):Ⅲ期[MD=-0.16,95%CI(-0.40,0.08)]、Ⅲ~Ⅳ期[MD=-0.40,95%CI(-1.15,0.35)]治疗组优势疗效不明显,Ⅳ期[MD=-1.28,95%CI(-1.62,0.94)],治疗组优于对照组。根据不同治疗时间进行亚组分析:④尿素氮(BUN):>6周[MD=-1.66,95%CI(-2.35,-0.97)]治疗组优于对照组,≤6周[MD=-0.10,95%CI(-0.42,0.22)]治疗组优势不明显;⑤血肌酐(SCr):>6周[MD=-21.12,95%CI(-35.55,-6.69)]治疗组优于对照组,≤6周[MD=-23.42,95%CI(-61.78,-14.95)]治疗组优势不明显。报道的不良反应较少。结论参芪地黄汤在治疗气阴两虚型Ⅲ~Ⅳ期DKD的临床疗效总体显著,安全性较好,但需要更多大样本、多中心、高质量的随机对照试验进一步验证。
Objective To evaluate the efficacy and adverse effects of Shenqi Dihuang Decoction in the treatment of stageⅢ~Ⅳdiabetic kidney disease(DKD)with deficiency of both Qi and Yin.Methods We searched the databases of CNKI,WANFANG Data,VIP information,SinoMed,PubMed,Embase,the randomized controlled trials(RCTs)on Shenqi Dihuang Decoction in the treatment of stageⅢ~ⅣDKD with deficiency of both Qi and Yin were collected from the establishment of the database to November 2021.The data were extracted and assessed for risk of bias using ROB 2.0,Meta-analysis using RevMan 5.4 software,and quality of evidence evaluation using GRADE system for outcome indicators.Results A total of 13 articles representing 962 patients.Meta-analysis showed that Shenqi Dihuang Decoction improved the efficacy of TCM symptoms(MD=-4.39,95%CI[-6.27,-2.51]),subgroups analyses were performed according to different stages:(Ⅰ)Urinary albumin excretion rate(UAER)in the treatment group was better than that in the control group with stageⅢ(MD=-32.98,95%CI[-44.98,-20.97])and stageⅢ~Ⅳ(MD=-70.72,95%CI[-91.60,-49.84]).(Ⅱ)24 h urinary protein quantification(24 hUTP)in the treatment group was better than that in the control group with stageⅢ standardised mean difference[SMD=-0.28,95%CI(-0.65,0.08)],stageⅢ~Ⅳ(SMD=-1.10,95%CI[-1.64,0.56]).The difference is not significant in 24 hUTP with stageⅣ(SMD=-0.38,95%CI[-0.88,0.12])between groups.(Ⅲ)Fasting blood glucose(FBG)in the treatment group was better than that in the control group with stageⅢ(MD=-0.16,95%CI[-0.40,0.08]),Ⅳ(MD=-1.28,95%CI[-1.62,0.94]).The difference is not significant in FBG with stageⅣ(MD=-0.40,95%CI[-1.15,0.35])between groups.Subgroup analyses were performed according to different treatment durations:(Ⅳ)When blood urea nitrogen(BUN)>6 weeks(MD=-1.66,95%CI[-2.35,-0.97]),the curative effect was better in the treatment group than in the control group,but when BUN≤6 weeks(MD=-0.10,95%CI[-0.42,0.22]),the curative effect was not significant between groups.(Ⅴ)When seru
作者
刘芬
王郁金
苏衍进
谭从娥
王相东
邢文文
LIU Fen;WANG Yujin;SU Yanjin;TAN Conge;WANG Xiangdong;XING Wenwen(TCM diagnosis teaching and research section,Shaanxi University of Chinese Medicine,Xianyang,Shaanxi 712000;Department of Endocrinology,Shaanxi University of Chinese Medicine,Xianyang,Shaanxi 712000)
出处
《河北中医》
2023年第2期330-338,共9页
Hebei Journal of Traditional Chinese Medicine
基金
陕西省科技厅重点研发计划(编号:2020SF-336)
陕西中医药大学“肾虚证候病机及证治规律研究”创新团队项目(编号:2019-QN06)。
关键词
参芪地黄汤
糖尿病肾病
气阴两虚
META分析
Shenqi Dihuang Decoction
Diabetic Nephropathy
Qi and Yin deficiency
Meta Analysis
