【摘要】 目的:评价益气清热活血中药治疗糖尿病肾病(DN)尿蛋白的疗效。方法:计算机检索美国医学文摘数据库(1978—2008)、维普中文科技期刊全文数据库(1989—2009)、中国生物医学文献数据库(1990—2009)、万方中华医学会数字化期刊(1998—2008)及万方数字化期刊全文数据库(1984—2009)。收集以血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)为对照的益气清热活血中药治疗DN尿蛋白的随机对照试验(RCT)和半随机对照试验。两名评价员独立评价纳入试验的方法学质量,采用Revman 4.2.2软件做Meta分析。结果:纳入39篇中文RCT,全部论文被评为C级。Meta分析结果显示:ACEI或ARB基础上联合益气清热活血中药可进一步降低DN的尿微量白蛋白排泄率(WMD=-40.679,5%CI(-58.65,-22.69),P<0.00001)2、4h尿微量白蛋白量(WMD=-83.11,95%CI(-110.18,-56.04),P<0.00001)和24h尿蛋白定量(SMD=-0.70,95%CI(-0.81,-0.58),P<0.00001);单用益气清热活血中药降低尿微量白蛋白排泄率的作用可能与ACEI或ARB相似(WMD=0.599,5%CI(-42.14,43.31),P=0.98);降低24h尿微量白蛋白量(WMD=-26.86,95%CI(-40.44,-13.29),P=0.0001)和24h尿蛋白定量(SMD=-1.48,95%CI(-2.27,-0.70),P=0.0002)作用更明显。结论:益气清热活血中药治疗DN尿蛋白有一定疗效。该系统评价所纳入研究方法学上存在缺陷,证据强度不高,益气清热活血中药在降低DN尿蛋白方面的疗效仍需深入研究。更多还原

【Abstract】 Objective:To assess the efficacy of Chinese herbal medicine suPPlementing qi,clearing heat and activating blood circulation in the management of urine Protein in diabetic nePhroPathy. Methods:Search the following database:Medline(1978-2008) ,VIP(1989-2009) ,CBM disc(1990-2009) ,CMA digital Periodicals(1998-2008) and Wanfang full-text database (1984 -2009) . Randomized or semi-randomized controlled trials (RCT) which comPared Chinese herbal medicine suPPlementing qi,clearing heat and activating blood circulation with ACEI or ARB were collected. Two indePendent reviewers evaluated themethodological quality of included studies and meta-analysis was Performed. Results:39 Chinese RCTs were included in this review. All trials were classified as grade C. The results of meta-analysis demonstrated that comPared with ACEI or ARB alone, combination with Chinese herbal medicine suPPlementing qi,clearing heat and activating blood circulation could significantly decrease the urinary albumin excretion rate(WMD =-40. 67,95% CI(58. 65,22. 69) ,P < 0. 00001) ,the 24-hour urinary albumin excretion(WMD =-26. 86,95% CI(40. 44,13. 29) ,P = 0. 0001) and the 24-hour urinary Protein excretion (SMD = -0. 70,95%CI(-0. 81,-0. 58) ,P <0. 00001) ; Herbal medicine alone could significantly decreased the 24-hour urinary albumin excretion(WMD =-26. 86,95% CI(40. 44,13. 29) ,P = 0. 0001) and the 24-hour urinary Protein excretion (SMD = -1. 48,95%CI(-2. 27,-0. 70) ,P = 0. 0002) ,but no significant difference in the reduction of the urinary albumin excretion rate(WMD = 0. 59,95% CI(42. 14,43. 31) ,P = 0. 98) . Conclusion:The Poor methodological quality of included studies seriously weakened the validity of the meta-analysis. So the efficacy of Chinese herbal medicine suPPlementing qi,clearing heat and activating blood circulation in the management of urine Protein in diabetic nePhroPathy should be determined by more RCTs of high quality comPared with ACEI or ARB.更多还原