基于网状Meta分析探索6种中成药治疗糖尿病肾病氧化应激反应的疗效＊

目的 基于网状Meta分析的方法对不同中成药治疗糖尿病肾病氧化应激反应的有效性及安全性进行评估。方法 计算机检索中国期刊全文数据库（CNKI）、万方数据库（WanFang）、维普数据库（VIP）、SinoMed数据库、PubMed数据库、Cochrane Library数据库等国内外数据库,检索时间均为建库至2020年2月。首先按预先制定的纳入与排除标准进行文献筛选和资料提取。然后采用Cochrane系统5.3推荐的偏倚风险评价工具对纳入的RCTs进行质量评估。紧接着采用Gemtc软件进行数据分析,采用STATA14.0软件进行绘图。结果 最终纳入关于中成药改善DN患者氧化应激水平的随机对照试验（RCT）共计30篇,涉及6种中成药,8种治疗方案,总计3354例患者,其中治疗组1693例,对照组1661例。网状Meta分析结果显示,SOD指标共产生7个直接比较和21个间接比较,其中,百令胶囊、黄葵胶囊、金水宝颗粒、糖脉康颗粒、益肾化湿颗粒联合常规治疗的疗效优于西医常规治疗,且差异具有统计学意义;中成药疗效排序结果为：益肾化湿颗粒 > 雷公藤多甙片联合黄葵胶囊 > 雷公藤多甙片 > 百令胶囊 > 黄葵胶囊 > 金水宝颗粒 > 糖脉康颗粒;MDA指标共产生7个直接比较和21个间接比较,百令胶囊、黄葵胶囊联合常规治疗的疗效较西医常规治疗更好,且差异具有统计学意义;8种治疗方案疗效排序结果为：雷公藤多甙片联合黄葵胶囊 > 雷公藤多甙片 > 黄葵胶囊 > 百令胶囊 > 益肾化湿颗粒 > 糖脉康颗粒 > 金水宝颗粒;UAER指标共产生5个直接比较和11个间接比较,其中黄葵胶囊联合西医常规治疗在减少UAER方面优于西医常规治疗,中成药之间排序为：黄葵胶囊 > 金水宝颗粒 > 百令胶囊 > 益肾化湿颗粒 > 糖脉康颗粒。结论 在西医常规基础上辅于中成药的治疗方案较单纯西医常规治疗方案,在提高血清SOD水平,降低血液中MDA含量方面明显优于后者。此外,由于涉及不同的中成药的RCTS中的研究数量及质量存在差异,本研究的中成药排序结果有待进一步RCT临床试验验证。

Exploring the Efficacy of Six Chinese Patent Medicines in Treating Oxidative Stress in Diabetic Nephropathy Based on Reticulated Meta

Objective To evaluate the effectiveness and safety of different Chinese patent medicines in the treatment of diabetic nephropathy (DN) oxidative stress based on the method of mesh meta-analysis.Methods Computer retrieval of Chinese Journal Full Text Database (CNKI), WanFang Database (VanFang), Vip Database (VIP), SinoMed Database, PubMed Database, Cochrane Library Database and other domestic and foreign databases was conducted. The search time was from the establishment of the database to February 2020. First of all, according to the pre-established inclusion and exclusion criteria for literature screening and data extraction. Then the bias risk assessment tool recommended by Cochrane system 5.3 was used to evaluate the quality of the included RCTs. Then Gemtc software was used for data analysis, and STATA14.0 software was used for drawing.Results A total of 30 randomized controlled trials (RCTs) on Chinese patent medicines to improve the level of oxidative stress in patients with DN were included, involving 6 Chinese patent medicines and 8 treatment regimens, totaling 3354 patients, including 1693 patients in the treatment group and 1661 in the control group example. Reticulated Meta analysis results showed that SOD indicators produced a total of 7 direct comparisons and 21 indirect comparisons, of which Bailing Capsules, Huangkui Capsules, Jinshuibao Granules, Tangmaikang Granules, Yishenhuashi Granules combined with conventional treatment It was superior to the conventional treatment of Western medicine, and the difference was statistically significant; the results of the ranking of the efficacy of Chinese patent medicines were: Yishen Huashi Granules > Tripterygium wilfordii Tablets combined with Huangkui Capsules > Tripterygium wilfordii Tablets > Bailing Capsules > Huangkui Capsules > Huangkui Capsules > Jinshuibao Granules > Tangmaikang Granules; MDA indicators produced a total of 7 direct comparisons and 21 indirect comparisons. The efficacy of Bailing Capsules and Huangkui Capsules combined with conventional treatment was better than that of Western medicine, and the difference was statistically significant; The results of the various treatment programs were as follows: Tripterygium wilfordii polyglycosides Tablets combined with Huangkui Capsules > Tripterygium wilfordii polyglycosides Tablets > Huangkui Capsules > Bailing Capsules > Yishen Huashi Granules > Tangmaikang Granules > Jinshuibao Granules; UAER index total 5 direct comparisons and 11 indirect comparisons were generated, of which Huangkui Capsules combined with conventional Western medicine treatments were superior to Western traditional treatments in reducing UAER. The order of Chinese patent medicines was: Huangkui Capsules > Jinshuibao Granules > Bailing Capsules > Yishen Huashi Particles > Tangmaikang Particles.Conclusion The treatment scheme supplemented with Chinese patent medicine on the basis of Western medicine routine is significantly better than that of Western medicine alone in terms of increasing serum SOD level and reducing blood MDA content. In addition, due to the differences in the number and quality of studies in RCTS involving different Chinese patent medicines, the results of the ranking of Chinese patent medicines need to be further verified by this research group.