The efficacy and safety of Chinese herbal medicine combined with ACEI/ARB for treatment of incipient diabetic nephropathy: A meta-analysis

摘要

Abstract Objective: This meta-analysis evaluated the efficacy and safety of Chinese herbal medicine (CHM) combined with angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin-receptor blockers (ARBs)for treatment of incipient diabetic nephropathy(IDN). Methods: Nine data bases were searched for randomized controlled trials of Chinese herbal medicine(CHM) and ACEI/ARB for treatment of IDN. Included articles were published between January2006 and December 2016. All studies were divided into prescriptions containing both Astragali Radix and Rehmanniae Radix (i subgroup), Astragali Radix(Huangqi) or Rehmanniae Radix(Dihuang) (ii subgroup), neither Astragali Radix nor Rehmanniae Radix (iii subgroup). Review Manager 5.3was used for subgroup analysis. Results: In total, 28 RCTs with 2017 patients were included. The results showed 1)the urinary albumin excretion rate (UAER) can be reduced significantly using CHM with ACEI or ARB for treatment of IDN compared to ACEI or ARB alone, and reduction of the UAER of the i subgroup was superior to that of the other two subgroups;2)serum creatinine (Scr) levels can be reduced significantly using CHM combined with ACEI or ARB, and reduction of Scr in the ii subgroup was superior to that in the iii subgroup;3)reduction of BUN in group A was not better than that in group B. Conclusion: In summary, CHMs combined with ACEI/ARB can decrease UAER and Scr significantly compared to the use of ACEI/ARB during IDN treatment. The effect was more significant in the CHM group containing Astragali Radix or Rehmanniae Radix. The application of Astragali Radix and Rehmanniae Radix should be emphasized in third stage diabetic nephropathy.