清热活血中药治疗糖尿病肾病尿蛋白的Meta分析

目的评价清热活血中药在控制糖尿病肾病（DN）尿蛋白方面的疗效。方法计算机检索美国医学文摘数据库（1978～2008年）、维普中文科技期刊全文数据库（1989～2009年）、中国生物医学文献数据库（1990～2009年）、万方中华医学会数字化期刊（1998～2008年）及万方数字化期刊全文数据库（1984～2009年）。收集西药联合清热活血中药或单用清热活血中药与西药相比较治疗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8篇中文RCT,全部论文被评为C级。Meta分析结果显示：与单用西药相比,联合清热活血中药可进一步减少DN的尿微量白蛋白排泄率WMD=-42.34,95%CI（-53.84,-30.84）,P〈0.00001]、24小时尿微量白蛋白量SMD=-1.46,95%CI（-2.50,-0.41）,P=0.006]、24小时尿蛋白定量WMD=-0.58,95%CI（-0.91,-0.26）,P=0.0004];单用清热活血中药在降低DN 24小时尿蛋白定量上的疗效可能与ACEI或ARB相似WMD=-1.81,95%CI（-3.59,-0.04）,P=0.05]。结论清热活血中药治疗DN尿蛋白有一定疗效。本系统评价所纳入研究数量偏少,且方法学上存在缺陷,证据强度不高,清热活血中药在降低DN尿蛋白方面的疗效仍需深入研究。

The efficacy of Chinese herbal medicine clearing heat and activating blood circulation in the management of urine protein in diabetic nephropathy:A meta-analysis

Objective To assess the efficacy of Chinese herbal medicine clearing heat and activa- ting 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 clearing heat and activating blood circu- lation with western medicine were collected. Two independent reviewers evaluated the methodological quality of included studies and meta-analysis was performed. Results 8 Chinese RCTs were included in this re- view. All trials were classified as grade C. The results of meta-analysis demonstrated that compared with western medicine alone, combination with Chinese herbal medicine clearing heat and activating blood circu- lation could significantly decreased the urinary albumin excretion rate WMD =-42. 34,95% CI （-53. 84,- 30. 84） ,P 〈0. 013001 ] ,the 24-hour urinary albumin excretion SMD = -1.46,95% CI（ -2. 50,-0.41 ） ,P = 0. 006 ] and the 24-hour urinary protein excretion WMD = -0. 58,95% CI（-0. 91 ,-0. 26） ,P=O. 0004] ;But no significant difference was found between herbal medicine alone and ACEI or ARB in the reduction of 24- hour urinary protein excretion. Conclusion The poor methodological quality of included studies seriously weakened the validity of the meta-analysis. So the efficacy of Chinese herbal medicine 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.