Systematic Evaluation Of Astragalus Injection Combined With ACEI Or ARB For The Treatment Of Stage III And IV Diabetic Nephropathy

Background:Diabetic nephropathy is a kidney injury caused by diabetes.It's therapeutic method mainly is the RAAS blockers drugs that can reduce blood pressure,reduce urinary protein and delay the decline of glomerular filtration rate.Traditional Chinese medicine for treatment of the disease has accumulated a wealth of experience,and has a very good effect.With the development of medicine,the combination treatmnent of traditional Chinese medicine and modern medicine has become more and more prevalent,and a large amount of studies that using Astragalus injection combined with ACEI or ARB as the treatment of this disease were publishied.However,the results of these studie were different from each other,it is necessary to make a systematic review to evaluate the efficacy of those studies.There have been some meta-analysises about this research,but the previous meta-analysises were publishied three years ago,and many of the clinical trials about this research have published in the past three years,so it is necessary to update.Purposes:Useing the EBM to evaluate the efficiency and safety of the treament of stage? and ? diabetic kidney disease by combining Astragalus injection with ACEI or ARB,so as to provide a scifentific basis for clinical practice.Method:We searched China national knowledge infrasructure(CNKI),Wanfang database,Weipu datebase,China Biomedical Literature Database(CBM),Embase,Pubmed,Cochrane Library,time from building datebase to March 31st 2016.Collecting clinical randomized controlled trials included in Astragalus injection combine ACEI or ARB compared with ACEI or ARB in treating stage ? and ? diabetic kidney disease.Then screened studys according to the inclusive and exclusive criter,and using the Cochrane Collaboration bias risk assessment tool evaluated the quality of the included trials.Then analysis information useing the RevMan 5.3 software.And finally explained and discuss the results.Results:27 studies were included in this systematic review,including RCT 24 and quasi-RCT 3.The results of the system review are following:1 Primary indicators:1.1 quality of life:No studies reported the indicators of quality of life.1.2 The incidence of ESRD:No studies reported the incidence of ESRD.1.3 Drug adverse reactions:3 studies reported that there were some adverse reactions,including dry cough,increase blood Cr casually,increase serum potassium,dizziness and headache.11 studys reported no adverse reactions.2 Secondary indicators:2.1 UAER:The results of those trials showed there were statistically significant differences between treatment groups and control groups.2.2 24h urinary protein quantity:The results of those trials showed there were statistically significant differences between treatment group and control group.2.3 Blood creatinine:This systematic review failed to evaluated this indicator.2.4 Blood urea nitrogen:The results of ARB group showed that there is no significant difference between treatment group and control group.This systematic review faied to evaluated this indicator in ACEI group.2.5 Fasting blood glucose:The results of ARB group showed that there is no significant difference between treatment group and control group.This systematic review failedto evaluated this indicator in ACEI group.2.6 2h postprandial blood glucose:There is significant difference between treatment group and control group.2.7 Blood pressure:This systematic review failed to evaluated this indicator.2.8 Total cholesterol:This systematic review failed toevaluated this indicator.2.9 Triglyceride:This systematic review failed to evaluated this indicator.2.10 Total effective rate:there were statistically significant difference between treatment group and control group.Conclusions:First,compared with foundation treatment+ACEI or ARB,the foundation treatment + astragalus injection combined ACEI or ARB is more valid for the diabetic nephropathy patients who are in stage III and IV stage in improving total effective rate.Second,compared with foundation treatment+ACEI or ARB,the foundation treatment +astragalus injection combined ACEI or ARB is more valid for the diabetic nephropathy patients who are in stage III stage in the spect of indecreasing the UAER,reducing the 24h urine protein quantity and 2 hour postprandial blood glucose.Third,this system review failed to compare other indicators and security indices.