Yang Yunyi, Sha Wenjun, Hou Keke, Xu Yuanying, Tan Shufa, Yin Hongping, Chen Lin, Lei Tao
Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China.
Evid Based Complement Alternat Med. 2022 Sep 30;2022:1720749. doi: 10.1155/2022/1720749. eCollection 2022.
Wuling powder is a classical formula of traditional Chinese medicine (TCM), which is extensively applied to treat diabetic nephropathy (DN). However, there are no related reports on systematically evaluating the efficacy of Wuling powder in the treatment of DN. Targeted at this, this study was developed.
This study systematically searched related articles from nine databases, including PubMed, Cochrane Library, Embase, Web of Science, China Knowledge Infrastructure (CNKI), China Biomedical CD-ROM (Sino Med), Wanfang database, Vipers database (VIP), and the China Clinical Trials Registry website. The randomized controlled trials (RCTs) involving Wuling Power to treat DN were included, which were published from the established data of the above databases to March 2022. In addition, the language of the studies was not restricted. Studies were meta-analyzed using the RevMan 5.4 software given in the Cochrane Collaboration Network. The treatment efficacy was measured using the weighted mean differences (WMD) and 95% confidence intervals (CI).
24 studies were included for the final analysis. 24 h urine volume (WMD = 357.95; 95% CI [322.83, 393.06], < 0.00001), 24 h urine protein quantification(24 h UPQ) (WMD = -1.30; 95% CI [-1.82, -0.78], < 0.00001), serum creatinine (Scr) (WMD = -10.17; 95% CI [-11.13, -9.21], < 0.00001), blood urea nitrogen (BUN) (WMD = -1.62; 95% CI [-2.30, -0.93], < 0.00001), urinary albumin excretion rate (UAER) (WMD = -24.73; 95% CI [-35.46, -13.99], < 0.00001), fasting blood glucose (FBG) (WMD = -0.63.95% CI [-0.97, -0.30], = 0.002), glycated hemoglobin (WMD = -0.11; 95% CI [-0.30, 0.08], =0.26), total cholesterol (TC) (WMD = -0.63; 95% CI [-1.23, -0.04], =0.04), triglycerides (TG) (WMD = -0.46. 95% CI [-0.70, -0.23], =0.0001), high-density lipoprotein cholesterol (HDL-C) (WMD = -0.32; 95% CI [0.03, 0.62], =0.03), low-density lipoprotein cholesterol (LDL-C) (WMD = -0.57; 95% CI [-0.77, -0.37], < 0.00001), and total effective rate (TER) (response ratio (RR) = 1.40; 95% CI [1.32, 1.48]; < 0.00001) were concluded. The Wuling powder in the treatment of DN was statistically significant in all the above outcome indicators, and the efficacy of the treatment group was better than that of the control group.
The results of this study provided evidence for the clinical application of Wuling powder to treat the DN, but it had to be further validated in higher-quality clinical studies.
五苓散是中医经典方剂，广泛应用于治疗糖尿病肾病（DN）。然而，目前尚无关于系统评价五苓散治疗DN疗效的相关报道。针对此，开展了本研究。
本研究系统检索了9个数据库中的相关文章，包括PubMed、Cochrane图书馆、Embase、科学网、中国知网（CNKI）、中国生物医学光盘数据库（Sino Med）、万方数据库、维普数据库（VIP）和中国临床试验注册中心网站。纳入从上述数据库建库至2022年3月发表的涉及五苓散治疗DN的随机对照试验（RCT）。此外，研究语言不限。使用Cochrane协作网提供的RevMan 5.4软件进行荟萃分析。治疗效果采用加权均数差（WMD）和95%置信区间（CI）进行衡量。
最终纳入24项研究进行分析。得出24小时尿量（WMD = 357.95；95% CI [322.83, 393.06]，P < 0.00001）、24小时尿蛋白定量（24 h UPQ）（WMD = -1.30；95% CI [-1.82, -0.78]，P < 0.00001）、血清肌酐（Scr）（WMD = -10.17；95% CI [-11.13, -9.21]，P < 0.00001）、血尿素氮（BUN）（WMD = -1.62；95% CI [-2.30, -0.93]，P < 0.00001）、尿白蛋白排泄率（UAER）（WMD = -24.73；95% CI [-35.46, -13.99]，P < 0.00001）、空腹血糖（FBG）（WMD = -0.63，95% CI [-0.97, -0.30]，P = 0.002）、糖化血红蛋白（WMD = -0.11；95% CI [-0.30, 0.08]，P = 0.26）、总胆固醇（TC）（WMD = -0.63；95% CI [-1.23, -0.04]，P = 0.04）、甘油三酯（TG）（WMD = -0.46，95% CI [-0.70, -0.23]，P = 0.0001）、高密度脂蛋白胆固醇（HDL-C）（WMD = -0.32；95% CI [0.03, 0.62]，P = 0.03）、低密度脂蛋白胆固醇（LDL-C）（WMD = -0.57；95% CI [-0.77, -0.37]，P < 0.00001）以及总有效率（TER）（反应比（RR） = 1.40；95% CI [1.32, 1.48]；P < 0.00001）。五苓散治疗DN在上述所有结局指标上均具有统计学意义，且治疗组疗效优于对照组。
本研究结果为五苓散治疗DN的临床应用提供了依据，但仍需在更高质量的临床研究中进一步验证。
