Zhou Peipei, Hao Zhenning, Xu Weilong, Zhou Xiqiao, Yu Jiangyi
Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
Front Pharmacol. 2022 Sep 12;13:936678. doi: 10.3389/fphar.2022.936678. eCollection 2022.
Diabetic nephropathy (DN) is one of the most serious chronic micro-vascular complications of diabetes and the leading cause of end-stage kidney disease (ESRD) worldwide, with reduced expectancy and quality of life and colossal financial and social burden worldwide. In spite of emerging treatments on DN, effective therapy on delaying the progression of DN is still lacking. In clinical practice, there are many studies focusing on (AM) capsules together with glycoside (TG) tablets in the treatment of DN, and excellent results have been obtained. The study aimed to evaluate the efficacy and safety of AM combined with TG in the treatment of DN. Databases including PubMed, Web of Science, Cochrane Library, Embase, CNKI, WF, and VIP were searched from their inception to 1 March 2022. The "risk of bias" evaluation tool produced by the Cochrane Collaboration Handbook was used for evaluating the quality of the included studies. Revman 5.3 software was used for meta-analysis. Here, 11 studies with a total of 1,072 participants were included for this meta-analysis. Our results showed that AM combined with TG plus basic treatment could lower levels of 24 h-UP [MD = -0.18; 95% CI: (-0.21, -0.14); < 0.00001], Scr [MD = -15.29; 95% CI: (-28.69, -1.88); = 0.03], and BUN [MD = -1.18; 95% CI: (-1.69, -0.68); < 0.00001]. Meanwhile, the adverse reaction rate increased in the combination group [RR = 1.88; 95% CI (1.26, 2.82); = 0.002]. Current evidence suggests that AM combined with TG may be more effective in the treatment of DN, which will be highly beneficial to further theoretical discussion and practical clinical applications. However, the safety cannot be ignored because of nearly increasing 2-fold adverse events, although they can be mitigated through systematic treatment. Meanwhile, due to low quality of the included studies, great possibility of publication bias, and large heterogeneity among different studies, the results of our review should be evaluated with more prudence and high-quality RCTs are warranted to confirm this in the future. www.crd.york.ac.uk, identifier CRD42022344359.
糖尿病肾病（DN）是糖尿病最严重的慢性微血管并发症之一，也是全球终末期肾病（ESRD）的主要病因，它降低了患者的预期寿命和生活质量，给全球带来了巨大的经济和社会负担。尽管针对DN出现了一些新的治疗方法，但仍缺乏有效延缓DN进展的疗法。在临床实践中，有许多关于（AM）胶囊联合（TG）片治疗DN的研究，并取得了良好效果。本研究旨在评估AM联合TG治疗DN的疗效和安全性。检索了包括PubMed、Web of Science、Cochrane图书馆、Embase、中国知网、万方数据和维普资讯在内的数据库，检索时间从建库至2022年3月1日。采用Cochrane协作网手册推荐的“偏倚风险”评估工具对纳入研究的质量进行评估。使用Revman 5.3软件进行荟萃分析。本荟萃分析共纳入11项研究，总计1072名参与者。我们的结果显示，AM联合TG加基础治疗可降低24小时尿蛋白（UP）水平[MD = -0.18；95%CI：（-0.21，-0.14）；P < 0.00001]、血肌酐（Scr）水平[MD = -15.29；95%CI：（-28.69，-1.88）；P = 0.03]和血尿素氮（BUN）水平[MD = -1.18；95%CI：（-1.69，-0.68）；P < 0.00001]。同时，联合治疗组的不良反应发生率有所增加[RR = 1.88；95%CI（1.26，2.82）；P = 0.002]。目前的证据表明，AM联合TG治疗DN可能更有效，这将对进一步的理论探讨和实际临床应用大有裨益。然而，安全性不容忽视，因为不良事件几乎增加了一倍，尽管可以通过系统治疗来减轻。同时，由于纳入研究质量较低、存在较大的发表偏倚可能性以及不同研究之间存在较大异质性，我们的综述结果应更加谨慎地评估，未来需要高质量的随机对照试验来证实这一点。www.crd.york.ac.uk，标识符CRD42022344359
