加味真武汤治疗糖尿病肾病Meta分析  

A Meta-analysis on Jiawei Zhenwu Decoction for Treating of Diabetic Nephropathy

作　　者：苏嘉楠 石岩[1] 杨宇峰[1] SU Jianan;SHI Yan;YANG Yufeng(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China)

机构地区：[1]辽宁中医药大学

出　　处：《辽宁中医药大学学报》2018年第11期73-79,共7页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：辽宁省高等学校创新团队基金项目(LT2014020)

摘　　要：目的：对公开发表的应用加味真武汤治疗糖尿病肾病的文献进行Meta分析,以评估加味真武汤治疗糖尿病肾病的疗效及安全性。方法：检索中国学术期刊全文数据库（万方）、中国生物医学文献数据库、中国学术期刊全文数据库（中国知网）、中文科技期刊数据库（维普）、Pubmed、Embase。时限：各数据库建库时间——2018年1月。收集加味真武汤治疗糖尿病肾病的随机对照试验及半随机对照试验。随后根据研究的纳入和排除标准对文献进行筛选,并进行质量评估,提取有效数据,采用RevMan5.3软件进行Meta分析。结果：本次研究共纳入10篇文献,涵盖患者总数882名。Meta分析结果显示：加味真武汤在总有效率[OR=4.37,95%CI（2.94,6.49）,Z=7.31（P〈0.00001）],改善患者24 h尿蛋白定量[WMD=-0.41,95%CI（-0.47,-0.34）,Z=12.19（P〈0.00001）],内生肌酐清除率[SMD=0.39,95%CI（0.18,0.59）,Z=3.68（P=0.0002）],尿素氮[WMD=-1.04,95%CI（-1.96,-0.13）,Z=2.23（P=0.03）],空腹血糖[WMD=-0.90,95%CI（-1.12,-0.68）,Z=7.95（P〈0.00001）],总胆固醇[WMD=-0.86,95%CI（-1.08,-0.65）,Z=7.83（P〈0.00001）],甘油三酯[WMD=-0.42,95%CI（-0.65,-0.19）,Z=3.54（P〈0.00001）],高密度脂蛋白[WMD=0.23,95%CI（0.19,0.28）,Z=9.98（P〈0.00001）],低密度脂蛋白[WMD=-0.67,95%CI（-1.02,-0.32）,Z=3.73（P=0.0002）],中医证候评分[WMD=-6.48,95%CI（-7.92,-5.03）,Z=8.80（P〈0.00001）],肢体浮肿[WMD=-0.43,95%CI（-0.52,-0.33）,Z=8.90（P〈0.00001）],夜尿频多[WMD=-0.53,95%CI（-0.63,-0.44）,Z=11.25（P〈0.00001）]方面均优于对照组。仅有1篇文献报道了加味真武汤治疗组可能有不良反应发生。结论：加味真武汤能够有效治疗糖尿病肾病,但仍需要纳入更多的随机对照试验以进一步验证该结论。Objective： To evaluate the safety and efficacy of Jiawei Zhenwu Decoction in treatment of diabetic nephropathy（DN）. Methods： Randomized controlled trial（RCT）or controlled clinicial trail on Jiawei Zhenwu Decoction in treatment of diabetic nephropathy was retrived by computer search and manual collection from CNKI, WanFang, Weipu, CCB, Pubmed, Embase. Time limit： From the establishment of the database to January,2018. There were two reserchers independently doing a data extraction according to the inclusion criteria of trials and quality assessment about the method of research and the extraction of valid data was then made baesd on meta-analysis. Results： Ten trials involving 882 patients who met the standard meta-analysis indicated that compared to control group, Jiawei Zhenwu Decoction group showed significant difference in effective rate [OR=4.37,95% CI（2.94,6.49）,Z=7.31（P〈0.00001）],24-hour urinary protein quantitative [ WMD=-0.41,95% CI（-0.47,-0.34）,Z=12.19（P〈0.00001）],Ccr [ SMD=0.39,95% CI（0.18,0.59）,Z=3.68（P=0.0002）],BUN [ WMD=-1.04,95% CI（-1.96,-0.13）,Z=2.23（P=0.03）],FPG [ WMD=-0.90,95% CI（-1.12,-0.68）,Z=7.95（P〈0.00001）],CHOL [WMD=-0.86,95% CI（-1.08,-0.65）,Z=7.83（P〈0.00001）],TG [ WMD=-0.42,95% CI（-0.65,-0.19）,Z=3.54（P〈0.00001）],HDL-C[WMD=0.23,95% CI（0.19,0.28）,Z=9.98（P〈0.00001）],LDL-C [ WMD=-0.67,95% CI（-1.02,-0.32）,Z=3.73（P=0.0002）],TCM syndrome score[ WMD=-6.48,95% CI（-7.92,-5.03）,Z=8.80（P〈0.00001）],limb swelling [ WMD=-0.43,95% CI（-0.52,-0.33）,Z=8.90（P〈0.00001）],polyuria at night[WMD=-0.53,95% CI（-0.63,-0.44）,Z=11.25（P〈0.00001）]. Only one trial report the adverse reactions occurrence induced by Jiawei Zhenwu Decoction. Conclusion： Based on the review, Jiawei Zhenwu Decoction may have positive effect on DN,but more high-quality RCTs are needed in order to draw firm conclusion.

关 键 词：糖尿病 糖尿病肾病 加味真武汤 META分析 

分 类 号：R587.2[医药卫生—内分泌]