Traditional Chinese Medicine Based on Zheng Differentiation versus Angiotensin Receptor Blocker/Angiotensin-converting Enzyme Antagonist in Efficacy of Treating Diabetic Kidney Disease: A Meta-analysis of Randomized Clinical Trials

摘要

Objective:To compare the efficacy of traditional Chinese medicine (TCM) based on Zheng differentiation with angiotensin receptor blocker/angiotensin-converting enzyme inhibitor (ARB/ACEI) in treating diabetic kidney disease (DKD) from the aspects of decreasing urinary microalbumin,declining 24-h urinary protein,reducing endpoint events,and renal function protection.Methods:The Chinese Biomedical Literature Database (CBM),the Chinese Academy of Sciences database (CNKI),the VIP Chinese journal database,Wanfang DATA,Medline database,Cochrane library,excerpt medical database (Embase),and Web of science were used for literature searching.The reviewer manager 5.3 software was utilized to analyze the data.Results:Twenty-four studies including 1956 participants were involved in this review.Results showed that TCM had a better effect (mean difference [MD],-23.20,95％ confidence interval [CI],-30.60 to-15.79,P ＜ 0.00001) than ARB/ACEI on lowering urinary albumin excretion rate (UAER) and urine albumin-to-creatinine ratio (MD-4.56 mg/mmol,95％ CI,-5.76 to-3.36,P ＜ 0.00001).Moreover,the advantage of decreasing UAER was greater as the follow-up period become longer (P =0.04).TCM also had a better effect in 24-h urinal protein,decreasing 0.36 g/24 h (95％ CI,-0.45 to-0.27,P ＜ 0.00001) more than the control in shorter follow-up period (ranged from 12 to 24 weeks) subgroup but only 0.08 g/24 h (95％ CI,-0.13 to-0.03,P =0.0006) in the longer follow-up period (＞24 weeks) subgroup.TCM worked as well as ACEI/ARB in reducing endpoint events (relative risk,0.67,95％ CI,0.20-2.224,P =0.51) and decreasing urinary albumin concentration (UAC) (MD,-16.50,95％ CI,-46.28-13.28,P =0.28).As for protecting renal function,TCM had an equal effect to AECI/ARB in improving creatinine clearance ratio (MD,-3.30,95％ CI,-6.66-0.03,P=0.05) or estimated glomerular filtration rate (MD,1.00,95％ CI,-0.59-2.58,P =0.22).However,TCM had a better effect in releasing the glomerular hyperfiltration state (MD,-9.64,95％ CI,-14.45 to-4.84,P ＜ 0.0001).Conclusions:TCM based on Zheng differentiation can work as well as ACEI/ARB in treating DKD and even better in decreasing urinary microalbumin and releasing glomerular hyperfiltration.It is a good alternative treatment of DKD.