Lv Xialin, Zhou Min, Liu Xiu, Xiang Qin, Yu Rong
Hunan University of Chinese Medicine, Changsha 410208, China.
Hunan Provincial Key Laboratory of Translational Research in Traditional Chinese Medicine Prescriptions and Zheng, Changsha 410208, China.
Evid Based Complement Alternat Med. 2022 Nov 1;2022:2133705. doi: 10.1155/2022/2133705. eCollection 2022.
To perform a systematic evaluation of the clinical efficacy and safety of Zhenwu decoction (ZWD) for the treatment of diabetic nephropathy (DN).
PubMed, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), and the WanFang databases were searched, and a systematic review and meta-analysis of randomized controlled trials (RCTs) were subsequently conducted to compare the efficacy and safety of ZWD combined with conventional Western medicine (CWM) to conventional therapy alone in the treatment of DN. The Cochrane Handbook for Systematic Reviews of Interventions and GRADE criteria were utilized to assess the quality of the included literature, and RevMan 5.3 software was used for statistical analysis.
13 randomized controlled trials were included, involving 1347 patients with diabetic nephropathy assigned into two subgroups according to the disease duration. The results revealed that compared with conventional therapy alone, ZWD combined with CWM treatment significantly improved the total effective rate (OR = 3.88, 95% CI = (2.87, 5.26), < 0.00001). Furthermore, ZWD combination therapy also decreased fasting blood glucose (MD = -0.72, 95% CI = (-0.97, -0.48), < 0.00001), BUN (MD = -1.92, 95% CI = (-3.19, -0.64), = 0.003), 24-hour urine protein (MD = -0.48, 95% CI = (-0.57, -0.39), < 0.00001), and serum creatinine levels (MD = -51.17, 95% CI = (-66.95, -35.39), < 0.00001). However,there was no statistical significance in the effect of combination therapy on creatinine clearance (MD = -0.64, 95% CI = [-8.21,6.92], P = 0.87). However, there was no statistical significance in the effect of combination therapy oncreatinine clearance (MD =-0.64, 95% CI=[-8.21,6.92], =0.87).
ZWD combined with CWM outperformed conventional Western medicine in DN treatment. However, further investigations via multicenter RCTs with rigorous designs and higher quality are still warranted.
对真武汤治疗糖尿病肾病（DN）的临床疗效和安全性进行系统评价。
检索PubMed、中国知网（CNKI）、维普中文科技期刊数据库（VIP）、中国生物医学文献数据库（CBM）和万方数据库，随后对随机对照试验（RCT）进行系统评价和荟萃分析，比较真武汤联合常规西药（CWM）与单纯常规治疗在DN治疗中的疗效和安全性。采用Cochrane干预措施系统评价手册和GRADE标准评估纳入文献的质量，使用RevMan 5.3软件进行统计分析。
纳入13项随机对照试验，共1347例糖尿病肾病患者，根据病程分为两个亚组。结果显示，与单纯常规治疗相比，真武汤联合CWM治疗显著提高了总有效率（OR = 3.88，95%CI =（2.87，5.26），P < 0.00001）。此外，真武汤联合治疗还降低了空腹血糖（MD = -0.72，95%CI =（-0.97，-0.48），P < 0.00001）、血尿素氮（MD = -1.92，95%CI =（-3.19，-0.64），P = 0.003）、24小时尿蛋白（MD = -0.48，95%CI =（-0.57，-0.39），P < 0.00001）和血清肌酐水平（MD = -51.17，95%CI =（-66.95，-35.39），P < 0.00001）。然而，联合治疗对肌酐清除率的影响无统计学意义（MD = -0.64，95%CI = [-8.21，6.92]，P = 0.87）。
真武汤联合CWM在DN治疗中优于单纯常规西药。然而，仍需要通过设计严谨、质量更高的多中心RCT进行进一步研究。
