基于贝叶斯网状Meta分析的中药汤剂联合普利或沙坦类药物治疗糖尿病肾病的研究

A Study on the Treatment of Diabetic Nephropathy with Chinese Herbal Decoction Combined with Priapril or Sartan Based on Bayesian Mesh Meta-Analysis

摘要: 目的：使用网状Meta分析的方法，以单纯ACEI/ARB (angiotensin receptor blockers, ARB; otenn- converti enzyme inhibitor, ACE)治疗为共同参照，对比补阳还五汤(Buyang huanwu decoction)、糖肾宁(Tangshen ning)、糖肾通络方(Tangshen Tongluo Recipe)、真武汤(Zhenwu decoction)、参芪地黄汤(Shenqi Dihuang Decoction)联合ACEI/ARB对糖尿病肾病的临床疗效。方法：计算机检索有关补阳还五汤、糖肾宁、糖肾通络方、真武汤、参芪地黄汤联合ACEI/ARB治疗糖尿病肾病的随机对照试验(Randomized controlled experiment)，2名工作者独立筛选，数据由Excel表格整理，分析使用Stata17.0和RevMan5.3软件。最终纳入46篇RCTs，共3617例患者，涉及6种干预措施。结果：Meta分析结果显示：在综合疗效方面，真武汤组的效果最佳；补阳还五汤组降低24 h尿蛋白排泄率(24 h UAER)的疗效最佳；真武汤组降低糖化血红蛋白(HBA1C)和C反应蛋白(CRP)的疗效最佳；糖肾通络方组降低尿素氮(BUN)的疗效最佳；参芪地黄汤组降低血肌酐(Scr)的疗效最佳。由于纳入文献质量相对偏低，得出的结论尚有待临床验证。结论：结合网状Meta分析结果和文献信息，在治疗有效率、糖化血红蛋白(HBA1C)和C反应蛋白(CRP)方面，均为真武汤组疗效最优；在降低24 h尿蛋白排泄率(24 h UAER)方面，补阳还五汤组疗效最优；在降低血肌酐(Scr)方面，参芪地黄汤组疗效最优；在降低尿素氮(BUN)方面，糖肾通络方组的疗效最优。

Abstract: Objective: To use mesh meta analysis method, with simple ACEI/ARB (angiotensin receptor blockers, ARB; otenn-converti enzyme inhibitor (ACE) treatment was adopted as co-reference. The results were compared with Buyang huanwu decoction, Tangshen ning, Tangshen Tongluo Recipe, Zhenwu decoction and Shenqi Dihuang De Clinical efficacy of coction combined with ACEI/ARB in diabetic nephropathy. Method: Computer retrieval relevant to fill five sou sugar, kidney ning Yang also, sugar renal t2dm party, when really Wu Shang, ginseng and astragalus combined ACEI/ARB randomized controlled trial (Randomized controlled experiment) for the treatment of diabetic nephropathy, 2 workers independent selection, data by Excel spreadsheet. The analysis was performed using Stata17.0 and RevMan5.3 software. Finally, 46 RCTs involving a total of 3617 patients were included, involving six interventions. Results: Meta analysis showed that: in terms of comprehensive efficacy, Zhenwu decoction group had the best effect; Buyang Huanwu Decoction group has the best effect on reducing 24 h urinary protein excretion rate (24 h UAER); Zhenwu decoction group had the best effect on reducing HBA1C and C-reactive protein (CRP). Tangshen Tongluo formula group had the best effect on reducing BUN. Shenqi Dihuang Decoction group had the best effect on reducing serum creatinine (Scr). Due to the relatively low quality of the included literature, the conclusions have yet to be validated clinically. Conclusion: Combined with the results of mesh meta-analysis and literature information, the efficacy of Zhenwu decoction group was the best in terms of treatment response rate, glycosylated hemoglobin (HBA1C) and C-reactive protein (CRP). Buyang Huanwu Decoction group has the best curative effect in reducing 24 h urinary protein excretion rate (24 h UAER). In terms of reducing serum creatinine (Scr), Shenqi Dihuang decoction group had the best effect; In terms of reducing BUN, Tangshen Tongluo formula group had the best effect.