- 1.Department of Internal Medicine, The PLA 520 Hospital, Mianyang 621000, China2.Department of Endocrinology, West China Hospital, Sichuan University, Chengdu 610041, China;
TIAN Haoming,
Email: hmtian999@yahoo.com.cn
Objective To review systematically the effectiveness and safety of astragaulus membranaceus in the treatment of diabetic nephropathy (DN).
Methods A Cochrane systematic review of all relevant randomized or quasi-randomized controlled trials of astragaulus membranaceus for diabetic nephropathy was performed. Clinical trials were searched for in the Cochrane Central Refister of Controlled Trials, MEDLINE, EMBASE, the Chinese Biological Medicine Database, and the Chinese Science and Technology Journal Full-text Database as well as in the references lists of all included trials. Two reviewers works independently to select studies, assess methodological quality and extract data. The following indexes were included to assess the clinical effectiveness and safety of astragaulus membranaceus: 24-hour urinary albumin excretion rate (UAER), 24-hour urinary protein, clearance of creatinine (Ccr), serum creatinine (Scr), blood urea nitrogen (BUN), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), triglyceride (TG), total cholesterol (TC), and serious adverse events.
Results Thirty-four clinical trials involving 2 356 patients met the inclusion criteria, but most of these trials were small and of low quality . A “funnel plot” showed asymmetry, which indicated possible publication bias, such that trials with negativeresults might not have been published. Meta-analyses showed that astragaulus membranaceus had some effects on the decrease of the 24-hour UAER, 24-hour urinary protein, Scr and BUN, and also on the improvement of Ccr. Therefore, astragaulus membranaceus, to a certain extent, was found to be effective in improving renal functions of DN patients. However, astragaulus membranaceus might have similar effects in decreasing the 24-hour UAER and Scr compared with angiotensin-converting enzyme inhibitor and angiotensin receptor blockers. Compared with other Chinese medicines, astragaulus membranaceus was more effective in decreasing the 24-hour urinary protein. No serious adverse events were observed during the treatment period.
Conclusion Astragaulus membranaceus has some effect and is relatively safe in treating patients with diabetic nephropathy. However, the present evidence was not enough to support the recommendation of astragaulus membranaceus as a routine drug in the clinical management of DN.Since most included trials are small and of low quality, high-quality, large-sample, multi-centre, randomized, double-blind and placebo-controlled trials of astragaulus membranaceus for DN are needed.
Citation： LIU Yihong,TIAN Haoming. Effect of Astragaulus Membranaceus on Diabetic Nephropathy: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2007, 07(10): 715-727. doi: Copy
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| 2. | Zeng F.Effect of astragaulus injection on early diabetic nephropathy and blood plasma endothel in. Journal of Traditional Chinese Medicine of Jiang Xi, 2005; 36(3): 26-27. |
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- 1. Zhang H, Shi X, Ji JL, et al. Effect of astragaulus injection on the urinary protein of diabetic nephropathy. Journal of Traditional Chinese Medicine of He Nan, 2001; 16(6): 36-37.
- 2. Zeng F.Effect of astragaulus injection on early diabetic nephropathy and blood plasma endothel in. Journal of Traditional Chinese Medicine of Jiang Xi, 2005; 36(3): 26-27.
- 3. Wang QL. Observations of effect of astragaulus injection on diabetic nephropathy. Zhong Yuan Medicine, 2004; 31(23): 6.
- 4. Xie BX, Zhang XF. Observations of effect of astragaulus injection and Prostaglandin E1 on diabetic nephropathy. Journal of Hu Nan Traditional Chinese Medical college, 2002; 22(3): 52-53.
- 5. Zhao Y. Combined therapeutic effect of astragaulus injection and Enalapril on Diabetic Nephropathy. Guang Xi medical Journal, 2003; 25(7): 1141-1143.
- 6. Wang LN. Observations of therapeutic effect of Losartan and astragaulus injection on diabetic nephropathy. Chinese Journal of Intergrated Traditional Chinese and Western Medicine of Nephropathy, 2003; 4(8): 471-472.
- 7. Guo QY, Tang CF, Fang XH, et al. Observations of therapeutic effect of astragaulus injection on early diabetic nephropathy. Chinese Journal of Country Medicine and Pharmacy, 2004; 11(3): 10-11.
- 8. Jiao QL. Combined therapeutic effect of astragaulus and XieSeTong injection and Irbesartan on early Diabetic Nephropathy. Guang Xi medical Journal, 2004; 26(10): 1484-1485.
- 9. An ZM, Dong XG, Deng YY, et al. Observations of therapeutic effect of western medicine and astragaulus injection on thirty cases of early diabetic nephropathy. Practical Journal of Chinese Medicine, 2004; 20(7): 368.
- 10. Wang YW. Observations of therapeutic effect of Kai Shi and astragaulus injection on diabetic nephropathy. Chinese Journal of Misdiagnostics, 2005; 5(3): 454-455.
- 11. Luo Y. Observations of Combined therapeutic effect of astragaulus and Prostaglandin E1 on Diabetic Nephropathy. Chinese Journal of Intergrated Traditional Chinese and Western Medicine of Nephropathy, 2004; 5(8): 485.
- 12. Huang W, Zhang W, Li SY, et al. Cl inical observations of Combined therapeutic effect of astragaulus injection and Lotensin on Diabetic Nephropathy. Shan Dong Journal of Traditional Chinese Medicine, 2004; 23(3): 161-162.
- 13. Cheng SH, Hou FY, Zhang LJ, et al. Observations terapeutic effect of astragaulus injection on Diabetic Nephropathy. Journal of Chinese medicine, 2000; 22(3): 207-209.
- 14. Ying LH. Observations of therapeutic effect of astragaulus injection on Diabetic Nephropathy. Modern Journal of Intergrated Traditional Chinese and Western Medicine of Nephropathy, 2005; 14(8): 988.
- 15. Xie BX. Clinical observations of astragaulus injection on eight-six cases of Diabetic Nephropathy. Journal of Zheng Jiang Medical college, 2001; 11(2): 168-169.
- 16. Cheng JH, Huang RG, Shi YX, et al. Observations of therapeutic effect of astragaulus injection on early Diabetic Nephropathy. Chinese Journal of Misdiagnostics, 2003; 3(8): 1156-1158.
- 17. .Liu YH, Yang L, Liu J, et al. Clinical observations of Combined therapeutic effect of astragaulus injection and Captopril on Diabetic Nephropathy. Chinese Journal of Intergrated Traditional Chinese and Western Medicine, 2005; 25(11): 993-995.
- 18. Fang WJ, Qing L, Jing J, et al. Study of comparison of astragaulus injection and Losartan on Diabetic Nephropathy. Chinese Journal of Phsician, 2003; 70-72.
- 19. Zhong XJ. Observations of therapeutic effect of astragaulus injection on 48 cases of early Diabetic Nephropathy. He Nan Journal of Diagnoses and therapy, 2002; 16(6): 447-448.
- 20. .Shi HB, Shun XY. Observations of therapeutic effect of astragaulusinjection and Xie Se Tong on early Diabetic Nephropathy. JETCM, 2001; 10(1): 35.
- 21. Wu WL, Dai YH. Observations of therapeutic effect of astragaulus injection on early Diabetic Nephropathy. Shang Hai Medicine, 2000; 21(3): 19-20.
- 22. Tang Y, Zhang GC. Clinial observations of astragaulus injection on the urinary protein of diabetic nephropathy. Practical Journal of Medicine, 1998; 14(9): 688-689.
- 23. Cai XJ, Ge SH, Zhou Y, et al. Observations of astragaulus and Hong Hua on early diabetic nephropathy. Practical Journal of Diabetes, 2005; 1(4): 39-41.
- 24. iang L, Xu Y, Ou YF, et al. Observations of Combined therapeutic effect of astragaulus injection and Benazepril on Diabetic Nephropathy. JETCM, 2005; 14(2): 144-145.
- 25. Xu YY, Ma ZH, Liu JH, et al. Effect on the urinary mic-protein of Diabetic Nephropathy. Clinical Study of Medicine, 2005; 22(1): 118-119.
- 26. Hu ZY, Cheng YP, Shen LM, et al. Observations of effect of astragaulus injection on dropsy of Diabetic Nephropathy. Chinese Journal of Intergrated Traditional Chinese and Western Medicine, 2000; 20(8): 618-619.
- 27. Liang BQ, Zhao AX. Observations of combined therapeutic effect of astragaulus injection and Benazepril on diabetic nephropathy. Chinese Journal of Intergrated Traditional Chinese and Western Medicine of Nephropathy, 2002; 3(2): 117.
- 28. Song EF, Jia RH, Yang DP, et al. A Discussion of renal protective function and mechanism of astragaulus on big rats. Chinese Journal of Geratology, 2004; 23(10): 744-745.
- 29. Jiao J. Study and improvement in protection mechanism of astragaulus on diabetic nephropathy. Jiling J TCM, 2004, 2(24): 54~55.
- 30. Yu L, Li JZ, Wang HY. Study and improvement in appl ication and mechanism of astragaulus membranaceus and Danggui on nephropathy diseases. Chin J Integr Tradit West Med, 2001; 21(5): 396-398.
- 31. Tao SJ, Yin ZN, Xu ZQ, et al. Influence of astragaulus injection onserum type IV collagen and transforming growth factor-β1 in diabetic nephropathy patients. Clinical Medicine of China, 2004; 20(3): 217-219.
- 32. Liu GC. Clinical observations of astragaulus injection on diabetic nephropathy. Clinical Medicine of China, 2004; 20(7): 601-602.
- 33. Zhou H. Observations of effect of astragaulus injection on the urinary albumin excretion rate of early diabetic nephropathy.JETCM, 2004; 13(10): 200-201.
- 34. Wen D, Zhang JZ, Ke H, et al. Clinical observations of astragaulus injection on diabetic nephropathy. JETCM, 2004; 13(6): 369-370.
- 35. Wang GL, Wei XP. Observations of curative effect of astragaulus injection on diabetic nephropathy. Chinese Journal of Primary Medicine and Pharmacy, 2003; 10(1): 38-39.
- 36. Wang YG, An XJ, Wu XZ, et al. Observations of effect of astragaulus injection on diabetic nephropathy and chronic Renal Failure. Journal of Intergrated Traditional Chinese and Western Medicine of Practical and Clinical First Aid, 1999; 6(5): 230.
- 37. Zhang XF, Gao HY, et al. Observations of effect of astragaulus injection on early diabetic nephropathy. ShangHai Medicine, 1999; 20(11): 20.
- 38. American Diabetes Association.Position statement:Diabetic nephropathy. Diabetes Care, 1998; 21: S50.
- 39. 焦剑. 黄芪对糖尿病肾病保护机制的研究进展. 吉林中医药, 2004; 2(24): 54-55.
- 40. 余凌, 李惊子, 王海燕. 黄芪、当归在肾脏疾病中的应用及其机制研究进展. 中国中西医结合杂志, 2001; 21(5): 396-398.
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