地黄叶总苷治疗糖尿病肾病的Meta分析  

Efficacy of total glycosides from Rehmannia glutinosa Libosch leaf extract for diabetic nephropathy:a meta-analysis

作　　者：陈孟林 文集[2] 谢林伸[1] 樊均明[3] CHEN Menglin;WEN Ji;XIE Linshen;FAN Junming(Department of Occupational Health and Toxicity/Nephrology,West China Fourth Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Rheumatology and Immunology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Nephrology,Chengdu Medical College,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西第四医院职业病中毒科/肾脏内科,成都610041 [2]四川大学华西医院风湿免疫科,成都610041 [3]成都医学院,成都610000

出　　处：《中国循证医学杂志》2021年第11期1293-1298,共6页Chinese Journal of Evidence-based Medicine

基　　金：四川省卫生健康委员会项目(编号:19PJYY1289)。

摘　　要：目的系统评价地黄叶总苷治疗糖尿病肾病的有效性。方法计算机检索PubMed、EMbase、MEDLINE、The Cochrane Library、Web of Science、CNKI、WanFang Data和VIP数据库,搜集关于地黄叶总苷治疗糖尿病肾病的随机对照试验(RCT),检索时限均从建库至2021年5月30日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入7个研究,包括504例糖尿病肾病患者。Meta分析结果显示,试验组和对照组在控制肌酐[MD=-1.71,95%CI(-3.97,0.56),P=0.14]、尿素[MD=-0.18,95%CI(-0.44,0.08),P=0.19]水平方面差异无统计学意义;在调节蛋白尿指标方面,试验组的尿白蛋白排泄率[MD=-39.41,95%CI(-48.46,-30.36),P<0.00001]、尿微量白蛋白[MD=-9.94,95%CI(-12.16,-7.73),P<0.00001]、24小时尿蛋白[MD=-0.67,95%CI(-0.85,-0.49),P<0.00001]均低于对照组;在反映长期血糖代谢水平指标糖化血红蛋白上,试验组与对照组差异无统计学意义[MD=-0.16,95%CI(-0.67,0.35),P=0.53];在短期血糖波动指标方面,仅有1个研究提示两组的空腹血糖和餐后2小时血糖水平没有明显差异;在血脂指标方面,仅1个研究提示,试验组胆固醇血清水平更低。结论在常规治疗基础上,地黄叶总苷联合血管紧张素II受体拮抗剂或胰激肽原酶,相比单用血管紧张素II受体拮抗剂或胰激肽原酶,能更好地改善糖尿病肾病的蛋白尿水平,但未明显改善肾功能指标,对长期和短期血糖代谢指标没有明显的影响,对血脂指标可能具有潜在的改善作用。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。Objective To systematically review the efficacy of total glycosides extracted from Rehmannia glutinosa Libosch leaf in the treatment of diabetic nephropathy.Methods Databases including PubMed,EMbase,MEDLINE,The Cochrane Library,Web of Science,CNKI,WanFang Data and VIP were electronically searched to collect randomized controlled trials of total glycosides from Rehmannia glutinosa Libosch for diabetic nephropathy from inception to May 30 th,2021.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.RevMan 5.4 software was then used to perform meta-analysis.Results A total of 7 RCTs involving504 patients were included.The results of meta-analysis showed that there were no significant differences in creatinine levels(MD=-1.71,95%CI-3.97 to 0.56,P=0.14)and urea(MD=-0.18,95%CI-0.44 to 0.08,P=0.19)between the two groups.In terms of regulating proteinuria,the urinary albumin excretion rate(MD=-39.41,95%CI-48.46 to-30.36,P<0.00001),urinary microalbumin(MD=-9.94,95%CI-12.16 to-7.73,P<0.00001),and 24-hour urinary protein(MD=-0.67,95%CI-0.85 to-0.49,P<0.00001)were all lower in the treatment group compared with control group.However,there were no differences between groups in terms of blood glucose metabolism as indicated by changes in levels of the long-term blood glucose metabolism indicator(HbA1 c:MD=-0.16,95%CI-0.67 to 0.35,P=0.53).Only one study suggested that short-term blood glucose metabolism indicators,fasting blood glucose and postprandial blood glucose levels were not different between groups.In terms of blood lipid metabolism,only one study suggested glycoside treatment produced lower serum levels of cholesterol and triglycerides compared with control group.Conclusions Current evidence suggests that adjunctive therapy with total Rehmannia glutinosa Libosch glycosides can benefit diabetic nephropathy patients more than angiotensin II receptor inhibitor or pancreatic kininogen by alleviating proteinuria and likely improving lipid metabolism.However,no benef

关 键 词：地黄叶总苷 糖尿病肾病 血管紧张素Ⅱ受体拮抗剂 胰激肽原酶 系统评价 META分析 

分 类 号：R259[医药卫生—中西医结合] R277.5[医药卫生—中医内科学]