补肾类中医经典方剂治疗糖尿病肾病Ⅲ—Ⅳ期的网状Meta分析OACSTPCD

OBJECTIVE:To evaluate and compare the clinical efficacy and safety of classical prescriptions of kidney-tonifying traditional Chinese medicine in the treatment of stage Ⅲ to Ⅳ diabetic nephropathy by network Meta-analysis.METHODS:CNKI,Wanfang Data,VIP,CBM,PubMed,Web of Science,the Cochrane Library and Embase databases were retrieved to collect the randomized controlled trials(the control group was treated with conventional treatment,while the observation group received traditional Chinese medicine classical prescriptions or modified prescriptions combined with conventional treatment;or both the control group and observation group received traditional Chinese medicine classical prescriptions or modified prescriptions combined with conventional treatment)for the treatment of stage Ⅲ to Ⅳ diabetic nephropathy with classical prescriptions of kidney-tonifying traditional Chinese medicine from the establishment of the database to Oct.31st,2023.R 4.2.1 software was used for statistical analysis and graphics drawing.RESULTS:A total of 67 literature were enrolled,including 6 classical prescriptions of Shenqi Dihuang decoction,Liuwei Dihuang pills(decoction),Zhenwu decoction,Jingui Shenqi pills,Jisheng Shenqi pills and Yuye decoction,with a total of 5476 patients.Results showed that Jingui Shenqi pills+conventional treatment had significant effect in reducing 24 h urinary protein(24 hUTP).In terms of reducing urinary albumin excretion rate(UAER),Liuwei Dihuang pills(decoction)+conventional treatment had significant effect.In terms of reducing serum creatinine(SCr),urea nitrogen(BUN),glycosylated hemoglobin(HbA1c)and fasting blood glucose(FBG),Jisheng Shenqi pills+conventional treatment had significant effect.In the subgroup of kidney Yin deficiency,Shenqi Dihuang decoction+conventional treatment had better therapeutic effect in reducing 24 hUTP,HbA1c and FBG;Liuwei Dihuang pills(decoction)+conventional treatment had better therapeutic effect in reducing UAER and BUN;Yuye decoction+conventional treatment had better therapeutic effect in reducing SCr.In the subgroup of kidney Yang deficiency,Jingui Shenqi pills+conventional treatment had better therapeutic effect in reducing 24 hUTP;Jisheng Shenqi pills+conventional treatment had better therapeutic effect in reducing UAER,SCr,BUN,HbA1c and FBG.Twelve literature reported the occurrence of adverse drug reactions,none of which were severe,and all of which resolved spontaneously or with symptomatic treatment.CONCLUSIONS:Existing evidence shows that the classical prescription of kidney-tonifying traditional Chinese medicine combined with conventional treatment has advantages in the treatment of stage Ⅲ to Ⅳ diabetic nephropathy,which can effectively reduce urinary protein,protect renal function,control blood glucose,and have fewer adverse drug reactions.However,its clinical efficacy and safety still need to be verified by multi-center,large-sample,long-term randomized controlled trials.