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.
目的:罗格列酮(RGZ)联合二甲双胍治疗初诊2型糖尿病(T2DM)的临床疗效和安全性。方法:40例初诊2型糖尿病联用罗格列酮和二甲双胍进行12周的治疗,测定治疗前后空腹血糖(FBG)、餐后2小时血糖(PPG)、糖化血红蛋白(HbA1c)、胰岛素、C-肽、甘油三脂、体重指数(BMI),胰岛素抵抗指数(IR)、血常规、肝、肾功能等。 结果:治疗前后对照,空腹及餐后血糖、胰岛素、甘油三脂、IRI降低,具有显著差异性(Plt;0.001),体重指数变化不大(Pgt;0.05),未发生肝肾功能损害。结论:罗格列酮联合二甲双胍治疗2型糖尿病,明显改善胰岛素抵抗,降糖疗效确切。