Wan-chun Ye 1#,Jian-zhong Ye 2,3#,Cheng Zheng 4#,Xiao-wei He 5,Jia-jie Huang 6,Ren Ye 6*.Combination therapy of tripterygium glycosides plus valsartan in diabetic nephropathy treatment: A systematic review and meta-analysis[J].Chinese Herbal Medicines (CHM),2019,11(2):222-230
雷公藤多苷联合缬沙坦治疗糖尿病肾病的系统回顾和荟萃分析
Combination therapy of tripterygium glycosides plus valsartan in diabetic nephropathy treatment: A systematic review and meta-analysis
  
DOI:10.1016/j.chmed.2018.08.011
中文关键词:  糖尿病肾病  荟萃分析  雷公藤多苷  缬沙坦
英文关键词:diabetic nephropathy  Meta-analysis  tripterygium glycosides  valsartan
基金项目:
Author NameAffiliation
Wan-chun Ye 1# 1. Department of Chemotherapy 2, Wenzhou Central Hospital, Wenzhou 325000, China 
Jian-zhong Ye 2,3# 2. State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China 3. Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310000, China 
Cheng Zheng 4# 4. Department of Cardiology, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China 
Xiao-wei He 5 5. Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning 530000, China 
Jia-jie Huang 6 6. Department of Traditional Chinese Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China 
Ren Ye 6* 6. Department of Traditional Chinese Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China 
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中文摘要:
      目的:评价雷公藤多苷联合缬沙坦治疗糖尿病肾病(DN)的疗效和安全性。 方法:本文对12个电子数据库进行综合研究。被纳入的研究分别由两位作者独立使用Review Manager(版本5.2)和Stata(版本12.0)进行提取和分析。 结果:共纳入12项随机对照试验,涉及829例患者。结果表明,联合用药能显著提高DN患者的总有效率(RR = 1.35, 95%CI [1.22, 1.50], P < 0.001)及血清白蛋白水平(平均差(MD) = 3.87, 95%CI [3.12, 4.62], P < 0.001),并显著降低24小时尿蛋白水平 (MD = 0.97, 95%CI [1.19, 0.76], P < 0.001)、尿白蛋白排泄率 (MD = 145.53, 95%CI [227.95, 63.11], P < 0.001)及尿β2微球蛋白水平 (MD = 11.86, 95%CI [13.02, 10.69], P < 0.001)。血清肌酐 (MD = 0.26, 95%CI [7.52, 7.00], P > 0.05),血尿素氮 (MD = 0.25, 95%CI [0.23, 0.74], P > 0.05) 和内源性肌酐清除率 (MD = 0.43, 95%CI [3.48, 2.62], P > 0.05) 无显著性差异。雷公藤多苷联合缬沙坦组不良反应发生率明显高于缬沙坦单药治疗组 (MD=3.41, 95%CI [1.34, 8.66], P < 0.05)。所纳入的所有监测指标均不存在发表偏倚。 结论:雷公藤多苷联合缬沙坦治疗DN疗效确切。然而,联合治疗的安全性有待进一步证实。
英文摘要:
      Objective To assess the efficacy and safety of the combination therapy of Chinese herbal medicines, tripterygium glycosides, plus valsartan for the treatment of diabetic nephropathy (DN). Methods A comprehensive research of 12 electronic databases was performed. Data of the included studies were extracted and analyzed independently by two authors, and were synthesized using Review Manager (version 5.2) and Stata (version 12.0). Results A total of 12 randomized controlled trials (RCTs) involving 829 patients were included. Pooled results showed that the combination therapy significantly increased total efficacy of DN patients [RR = 1.35, 95% CI (1.22, 1.50), P < 0.001], the level of serum albumin [Mean difference (MD) = 3.87, 95% CI (3.12, 4.62), P < 0.001], and significantly decreased 24 h urinary protein level [MD = ?0.97, 95% CI (?1.19, ?0.76), P < 0.001], urinary albumin-excretion rate [MD = ?145.53, 95% CI (?227.95, ?63.11), P < 0.001], urinary β2-microglobuli level [MD = ?11.86, 95% CI (?13.02, ?10.69), P < 0.001]. No significant differences were found in levels of serum creatinine [MD = ?0.26, 95% CI (?7.52, 7.00), P > 0.05), blood urea nitrogen [MD = 0.25, 95% CI (?0.23, 0.74), P > 0.05], and endogenous creatinine clearance rate [MD = ?0.43, 95% CI (?3.48, 2.62), P > 0.05]. However, tripterygium glycosides plus valsartan seemed to exert higher adverse reaction rate than valsartan monotherapy [MD = 3.41, 95% CI (1.34, 8.66), P < 0.05]. There were no publication bias for all of the pooled effect sizes. Conclusion Combination therapy of tripterygium glycosides plus valsartan may be effective for the treatment of DN. However, the safety of the combination therapy need to be further confirmed.
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