Systematic Review And Meta-analysis Of Integrated Traditional Chinese And Western Medicine In The Treatment Of Early Diabetic Nephropathy

Objects:To evaluate the curative effect of integrated traditional Chinese and Western medicine in the treatment of early diabetic nephropathy based on systematic review,and to explore the pathogenesis of early diabetic nephropathy,for provide scientific basis of the treatment of early diabetic nephropathy with integrated traditional Chinese and western medicine.Methods:1.Searched five major electronic databases:Chinese database includes:CNKI,Wanfang,VIP;foreign database includes:MEDLINE,CENTRAL,they were published from the inception to February 2017.2.The treatment group was treated with Chinese medicine and ACEI/ARB.The control group was treated with ACEI/ARB.The outcome index includes:UAER?ACR?FBG?2hPBG?HbA1c?SCr?BUN?TC?TG?LDL-C?HDL-C,HDL-C.;All papers obtained after the retrieval of randomized controlled clinical trials(RCT)of early diabetic nephropathy.3.Completion of the data extraction process,by extracted from the relevant content of PICOS of the RCT articles.4.Used Cochrane risk assessment tool to the inclusion of the quality of the evaluation of the articles' methodology.5.Used RevMan5.3 software to analyze and synthesize the outcome index.Meta-analysis was performed to measure the outcome index with low clinical heterogeneity,and the outcome index of high clinical heterogeneity was qualitatively described.6.Conducted the publication bias assessment.7.Explored the pathogenesis of early diabetic nephropathy based on pathogenesis frequency statistics and meta analysis.Results:A total of 23 randomized controlled trials involving 1582 patients with early diabetic nephropathy.The quality of the methodology was generally low.Through the quantitative analysis and single outcome to analyse the integrated traditional Chinese and Western medicine treatment of early diabetic nephropathy results:?Used the treatment of integrated traditional Chinese and Western medicine,regardless of which treatment of the traditional Chinese medicine,the effects of lower UAER?ACR?2hPBG?HbA1c?TG?LDL-C?HDL-C were better than the pure western medicine treatment;Traditional Chinese medicine and ACEI treatment group,regardless of which treatment of the traditional Chinese medicine,the effects of lower UAER?ACR?2hPBG?TC?TG?HDL-C were better than the pure ACEI treatment group;Traditional Chinese medicine and ARB treatment group,regardless of which treatment of the traditional Chinese medicine,the effects of lower UAER?ACR?2hPBG?HbA1c?TC?TG?LDL-C?HDL-C were better than the pure ARB treatment group.?Used the treatment of integrated traditional Chinese and Western medicine,which traditional Chinese medicine treatment was tonifying qi and yin and Huoxue Tongluo,the effects of lower UAER?ACR?HbA1c?TC?TG?HDL-C were better than the pure western medicine treatment;Traditional Chinese medicine of which tonifying qi and yin and Huoxue Tongluo and ACEI treatment group,the effects of lower UAER?ACR?TC?TG?HDL-C were better than the pure ACEI treatment group;Traditional Chinese medicine of which tonifying qi and yin and Huoxue Tongluo and ARB treatment group,the effects of lower UAER?ACR?2hPBG?TC?TG?LDL-C?HDL-C were better than the pure ARB treatment group.?Used the treatment of integrated traditional Chinese and Western medicine,which traditional Chinese medicine treatment was Huoxue Tongluo and nourishing yin and tonifying kidney,the effects of lower UAER?BUN were better than the pure western medicine treatment;Traditional Chinese medicine of which Huoxue Tongluo and nourishing yin and tonifying kidney and ARB treatment group,the effects of lower UAER?HbA1c?BUN were better than the pure ARB treatment group.?Traditional Chinese medicine of which Huoxue Tongluo and ACEI treatment group,the effects of lower UAER?TC?TG?LDL-C were better than the pure ACEI treatment group;?Traditional Chinese medicine of which Huoxue Tongluo and Regulating liver and kidney and ARB treatment group,the effects of lower UAER?ACR?FBG?2hPBG?HbA1c?TC?TG?LDL-C?HDL-C were better than the pure ARB treatment group.?Traditional Chinese medicine of which tonifying both yin and yang and ACEI treatment group,the effects of lower UAER were better than the pure ACEI treatment group.?Traditional Chinese medicine of which nourishing yin and tonifying kidney and ACEI treatment group,the effects of lower UAER were better than the pure ACEI treatment group.?Traditional Chinese medicine of which warming kidney-yang and ARB treatment group,theeffects of lower UAER?ACR?2hPBG?TC?TG?LDL-C?HDL-C were better than the pure ARB treatment group.We counted the number of effective clinical trials corresponding to each syndromes and found that the total incidence rate of the above six pathogens ranging from high to low were stagnation of blood stasis(20 trials,87.0%),deficiency of both qi and Yin(15 trials,65.2%),deficiency of kidney-yin(4 trials,17.4%),deficiency of kidney-yang(1 trials,40%),deficiency of both yin and Yang(1 trials,4%),yin deficiency of liver and kidney(1 trials,4%).Number of patients in effective clinical trials.We counted the number of patients in clinical trials corresponding to each syndromes and found that the total incidence rate of the above six pathogens ranging from high to low were stagnation of blood stasis(709 patients,89.1%),deficiency of both qi and Yin(549 patients,69.0%),deficiency of kidney-yin(122 patients,15.3%),deficiency of kidney-yang(35 patients,4.4%),deficiency of both yin and Yang(30 patients,3.8%),yin deficiency of liver and kidney(30 patients,3.8%).Conclusion:(1)The treatment of integrated traditional Chinese and Western medicine may have effect on the treatment of early diabetic nephropathy:The treatment of integrated traditional Chinese and Western medicine had better effects of lower UAER?ACR?2hPBG?HbA1c?TG?LDL-C?HDL-C than the pure western medicine treatment.(2)Eventually we get the pathogenesis of the early diabetic nephropathy may be:blood stasis,deficiency of both qi and Yin,deficiency of kidney-yin.