中医药治疗对糖尿病肾脏病患者尿液足细胞相关指标影响的Meta分析  

The Effect of Traditional Chinese Medicines on Urine Markers Of Podocyte Dysfunction In Patients With Diabetic Nephropathy:A Systematic Review and Meta-Analysis

作　　者：郑慧娟 周梦琪 刘伟敬[1,2] 王耀献 ZHENG Hui-juan;ZHOU Meng-qi;LIU Wei-jing;WANG Yao-xian(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700;Institute of Nephrology,Beijing University of Chinese Medicine,Beijing 100700;Beijing University of Traditional Chinese Medicine,Beijing 100029)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学肾病研究所,北京100700 [3]北京中医药大学,北京100029

出　　处：《世界中西医结合杂志》2022年第2期223-231,共9页World Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金项目(82004272);国家中医药管理局中医药传承与创新“百千万”人才工程(岐黄学者-国家中医药领军人才支持计划)(国中医药人教发[2018]12号)。

摘　　要：目的综合定量分析中医药治疗对糖尿病肾脏病(Diabetic kidney disease,DKD)患者尿液足细胞标记相关蛋白影响的随机对照试验(Randomized controlled trial,RCTs),以期为临床应用和开展相关实验研究提供参考依据。方法检索中文数据库(中国知网、维普、万方、中国生物医学文献)及英文数据库(Pubmed、Cochrane Library、Medline),时间范围为建库至2020年9月12日。按照研究预先制定的纳、排标准进行文献筛选和资料提取。采用偏倚风险评估工具对纳入研究进行质量评价,使用Stata 12.0软件进行数据分析,比较常规治疗基础上的中医药治疗与常规治疗对DKD患者尿中足细胞标志蛋白(Podocalyxin,PCX)、足细胞裂孔隔膜相关蛋白(nephrin、podocin)、24 h尿蛋白定量及尿微量白蛋白肌酐比(UACR)的影响。结果最终纳入22篇RCTs,共计1822例患者。分析结果显示,与常规治疗组比较,中医药治疗可降低DKD患者尿中PCX(n=20,SMD=-1.29,95%CI[-1.67,-0.91],P=0.000)、nephrin(n=6,SMD=-0.57,95%CI[-1.08,-0.05],P=0.000)和podocin(n=2,SMD=-0.85,95%CI[-1.20,-0.51],P=0.298)表达水平。同时,中医药治疗能降低24 h尿蛋白定量(n=8,SMD=-1.53,95%CI[-2.37,-0.69],P=0.000)及UACR(n=9,SMD=-0.56,95%CI[-0.88,-0.25],P=0.000)水平。结论提示中医药减少DKD患者蛋白尿排泄与对抗足细胞损伤有关。因受纳入研究的质量限制,中医药保护DKD患者足细胞的作用尚需更多高质量的RCT加以验证。Objective To analyze the published randomized controlled trials(RCTs)of the effects of traditional Chinese medicine treatment on urinary podocyte marker-related proteins in patients with diabetic kidney disease(DKD)by using Meta-analysis for comprehensive quantitative analysis,in order to provide a reference for clinical application and related experimental research.Methods Four major Chinese databases(China National Knowledge Infrastructure,VIP database,WanFang Database,Chinese Biomedical Literature)and English databases(PubMed,Cochrane Library,and Medline)were searched according to the search terms until September 12,2020.Literature screening and data extraction were performed independently by 2 researchers according to the inclusion and exclusion criteria.The quality of the included studies was evaluated with the Cochrane bias risk assessment tool.Data analysis was conducted by using Stata 12.0 software to compare the effects of TCMs based on conventional treatments and conventional treatments on urinary podocalyxin(PCX),podocin,nephrin,24 h urinary protein and urinary microalbumin creatinine ratio(UACR)in patients with DKD.Results Twenty-two RCTs were finally included,with a total of 1822 patients.The analysis results showed that,compared with the conventional treatment group,Chinese medicine treatment could reduce the urinary PCX(n=20,SMD=-1.29,95%CI[-1.67,-0.91],P=0.000),nephrin(n=6.SMD=-0.57,95%CI[-1.08,-0.05],P=0.000)and podocin(n=2,SMD=-0.85,95%CI[-1.20,-0.51],P=0.298)expression level.At the same time,traditional Chinese medicine treatment can reduce 24-hour urine protein quantitative(n=8,SMD=-1.53,95%CI[-2.37,-0.69],P=0.000)and UACR(n=9,SMD=-0.56,95%CI[-0.88,-0.25],P=0.000)level.Conclusion The results suggest that the reduction of proteinuria excretion in DKD patients by TCMs is related to the protection of podocytes from injury.However,due to the quality limitation of the included studies,more high-quality RCTs are needed to clarify the protective effect of TCMs on podocytes in DKD patients.

关 键 词：糖尿病肾脏病 尿液足细胞标志蛋白 META分析 中医药 

分 类 号：R587.2[医药卫生—内分泌]