中药配合氯沙坦治疗糖尿病肾病的系统评价

目的：系统评价中药配合氯沙坦治疗糖尿病肾病的疗效.方法：检索Cochrane、Pubmed、EMBASE、CBM、中国期刊全文数据库、维普、万方数据库中发表的中药配合氯沙坦的临床随机对照研究,纳入符合标准文献,Cochrane Handbook推荐方法评价研究质量,RevMan5.0软件进行Meta分析.结果：共纳入28篇文献,所有文献均被评为C级.Meta分析表明：中药配合氯沙坦治疗组较氯沙坦单独组,在降低尿白蛋白排泄率（WMD（random）95%CI：-47.05-64.99,-29.11]）、24 h尿蛋白定量（WMD （random）95%CI：- 0.56-0.75,-0.37]）、血清肌酐、血尿素氮、空腹血糖、总三酰甘油和总胆固醇方面,差异均有统计学意义.结论：对糖尿病肾病患者,中药配合氯沙坦疗效优于氯沙坦单独治疗.由于纳入文献质量不高,需要高质量的临床随机对照研究对其疗效及安全性进一步证实.

Systematic Evaluation of Traditional Medicine Plus Losartan for Diabetic Nephropathy

Objective:To systematically evaluate the effectiveness of Traditional Chinese Medicine (TCM) plus losartan compared with losartan alone, in the treatment of diabetic nephropathy. Methods:The Cochrane library, Pubmed, EMBASE, CBM, CNKI, VIP and Wanfang searched electronically, and randomized controlled trials (RCTs) were included. The quality of the included studies was assessed according to the criteria recommended by the Cochrane Handbook for systematic Reviews of interventions and Meta-analyses were performed for homogeneous studies by use of the Cochrane collaboration’s RevMan5.0 software. Results:Twenty-eight trials were included in this review. The quality of all studies was graded C (low). Meta-analyses showed that compared with losartan alone,TCM plus losartan could significantly decrease the urinary album in excretion rate (UAER) {WMD(random)95%CI:-47.05-64.99,-29.11]}, 24 h urinary protein excretion {WMD(random)95%CI:-0.56-0.75,-0.37]},and reduce the levels of serum creatinine (Scr), blood urea nitrogen (BUN), fasting plasma glucose (FPG), triglyceride (TG) and total cholesterol (TC).Conclusion:The treatment regimen of TCM plus losartan is superior to losartan alone in treating diabetic nephropathy. As the existing date have a high risk of bias, the current evidence is insufficient to define the efficacy of the combination treatment, and further large-scale, high-quality randomized controlled trials are needed.