中医“益气养阴”法辅助治疗2型糖尿病的Meta分析
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摘要
目的:系统评价中医"益气养阴"法辅助治疗2型糖尿病的有效性。方法:选取Pub Med,EMBase,CNKI和万方医学等数据库,搜集中医"益气养阴"法辅助治疗2型糖尿病的临床随机对照试验,采用STATA12. 0软件对数据进行Meta分析。结果:共纳入13项研究,共888例患者。与对照组比较,中医"益气养阴"法可显著降低观察组患者空腹血糖(FPG)(WMD=-0. 84,95%CI(-0. 97,-0. 71),P=0. 000)、餐后血糖(PPG)(WMD=-0. 73,95%CI(-1. 16,-0. 30),P=0. 001)和糖化血红蛋白(Hb A1c)(WMD=-0. 17,95%CI(-0. 32,-0. 02),P=0. 001)水平。三酰甘油(TG)和总胆固醇(TC)水平因研究间的高度异质性,仅进行描述分析。结论:中医"益气养阴"法有助于降低T2DM患者血糖和Hb A1c水平。
Objective: To evaluate the effects of the qi-boosting and yin-nourishing( Yi Qi Yang Yin) treatment as an adjuvant treatment of type 2 diabetes mellitus( T2 DM). Methods: By searching databases including Pub Med,EMBase,CNKI and Wanfang,etc.,we gathered Randomized Controlled Trails( RCTs) associated with"Yi Qi Yang Yin"as an adjuvant treatment of T2 DM. Statistical analysis was performed with STATA,ver. 12. 0. Results: Compared with the control group,statistical significance of the Qiboosting and Yin-nourishing( Yi Qi Yang Yin) Treatment was found in the reduction of the levels of fasting plasma glucose( WMD =-0. 84,95% CI(-0. 97,-0. 71),P = 0. 000),postprandial plasma glucose( WMD =-0. 73,95% CI(-1. 16,-0. 30),P =0. 001) and glycatedhaemoglobin A1 c( WMD =-0. 17,95% CI(-0. 32,-0. 02),P = 0. 001) of patients in the treatment group.The levels of triglyceride( TG) and total cholesterol( TC) among studies were highly heterogeneous,on account of which we only performed descriptive analysis. Conclusion: The Qi-boosting and Yin-nourishing( Yi Qi Yang Yin) Treatment is contributive in lowering the levels of plasma glucose and Hb A1 cof T2 DM patients. Nevertheless,due to limited methodological quality and sample size,further high-quality studies are needed for more definitive conclusions.
Objective: To evaluate the effects of the qi-boosting and yin-nourishing( Yi Qi Yang Yin) treatment as an adjuvant treatment of type 2 diabetes mellitus( T2 DM). Methods: By searching databases including Pub Med,EMBase,CNKI and Wanfang,etc.,we gathered Randomized Controlled Trails( RCTs) associated with"Yi Qi Yang Yin"as an adjuvant treatment of T2 DM. Statistical analysis was performed with STATA,ver. 12. 0. Results: Compared with the control group,statistical significance of the Qiboosting and Yin-nourishing( Yi Qi Yang Yin) Treatment was found in the reduction of the levels of fasting plasma glucose( WMD =-0. 84,95% CI(-0. 97,-0. 71),P = 0. 000),postprandial plasma glucose( WMD =-0. 73,95% CI(-1. 16,-0. 30),P =0. 001) and glycatedhaemoglobin A1 c( WMD =-0. 17,95% CI(-0. 32,-0. 02),P = 0. 001) of patients in the treatment group.The levels of triglyceride( TG) and total cholesterol( TC) among studies were highly heterogeneous,on account of which we only performed descriptive analysis. Conclusion: The Qi-boosting and Yin-nourishing( Yi Qi Yang Yin) Treatment is contributive in lowering the levels of plasma glucose and Hb A1 cof T2 DM patients. Nevertheless,due to limited methodological quality and sample size,further high-quality studies are needed for more definitive conclusions.
引文
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[15]饶线明,李亚林.益气养阴法治疗气阴两虚型糖尿病30例[J].福建中医药,2009,40(4):22-23.
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[17]宋杰,胡阳黔,刘坚,等.黄芪多糖对糖尿病大鼠血游离脂肪酸水平的影响及其机制[J].中国医药,2014,9(10):1475-1479.
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[19]李春桂,苗桂珍,朱学敏.益气养阴清热活血法治疗早期糖尿病肾病33例临床观察[J].河北中医,2009,31(8):1133-1135.
[20]王光明,王志高.益气养阴、活血通络法治疗早期糖尿病肾病63例[J].甘肃中医,2009,50(6):24-26.
[21]漆军华.中西医结合治疗气阴两虚型2型糖尿病临床观察[J].广西中医药,2011,34(2):16-17.
[22]王玉红.益气养阴汤联合二甲双胍片治疗2型糖尿病60例临床研究[J].河北中医,2012,34(8):1175-1177.
[23]闫玲玲,马建.祛胰抵方对2型糖尿病IR的临床观察[J].中医药学报,2012,40(1):113-115.
[24]蔡恩丽,武煜明,刘明星,等.自拟益气养阴活血汤治疗气阴两虚型糖尿病肾病60例疗效观察[J].云南中医中药杂志,2013,34(6):26-27.
[25]马婕.益气养阴清热活血法治疗早期糖尿病肾病的疗效及对血液流变学的影响[J].吉林中医药,2014,34(12):1225-1228.
[26]张国琼,尤强,吕蒙,等.益气养阴活血汤治疗2型糖尿病36例报告[J].糖尿病新世界,2014(19):35-36.
[27]胡仁明,谢颖,鹿斌,等.2型糖尿病患者高发“代谢性炎症综合征”[J].中华内分泌代谢杂志,2016,32(1):27-32.
[28]肖月星,闫秀峰,倪青,等.基于中医个体化诊疗平台和无尺度网络的2型糖尿病中药性味网络分布特征分析[J].天津中医药大学学报,2017,36(2):107-112.
[29]张怀民,傅秀慧,郑海洲.中药活性成分治疗2型糖尿病及其并发症作用机制的研究进展[J].中国药房,2016,27(22):3151-3153.
[30]Gu C,Zeng Y,Tang Z,et al.Astragalus polysaccharides affect insulin resistance by regulating the hepatic SIRT1-PGC-1α/PPARα-FGF21 signaling pathway in male Sprague Dawley rats undergoing catch-up growth[J].Mol Med Rep,2015,12(5):6451-6460.
[31]Shieh JP,Cheng KC,Chung HH,et al.Plasma glucose lowering mechanisms of catalpol,an active principle from roots of Rehmannia glutinosa,in streptozotocin-induced diabetic rats[J].J Agric Food Chem,2011,59(8):3747-3753.
[32]Hsu JH,Wu YC,Liu IM,et al.Dioscorea as the principal herb of Die-Huang-Wan,a widely used herbal mixture in China,for improvement of insulin resistance in fructose-rich chow-fed rats[J].J Ethnopharmacol,2007,112(3):577-584.
[33]马丽娜,毛新民,马晓丽,李琳琳,王烨,陶义存,王敬伟,郭佳佳,兰怡.蛋白干预对气阴两虚2型糖尿病大鼠氨基酸代谢谱的影响[J].中国中药杂志,2016,41(22):4226-4233.
[34]Stolar M.Glycemic control and complications in type 2 diabetes mellitus[J].Am J Med,2010,123(3):S3-11.
[35]Kohnert KD,Augstein P,Zander E,et al.Glycemic variability correlates strongly with postprandial beta-cell dysfunction in a segment of type 2 diabetic patients using oral hypoglycemic agents[J].Diabetes Care,2009,32(6):1058-1062.
[36]Patel A,Mac Mahon S,Chalmers J,et al.Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes[J].NEngl J Med,2008,358(24):2560-2572.
[37]李艳彬.2型糖尿病患者中医药治疗与血管并发症风险的相关性研究[J].保健文汇,2019,9(1):179.
[38]王金梅,郭俊杰.中医药治疗2型糖尿病胰岛素抵抗研究进展[J].世界中西医结合杂志,2017,12(11):588-589.
[39]张淑芳,吕树泉,苏秀海.2型糖尿病大血管病变中医药研究进展[J].中西医结合心脑血管病杂志,2016,14(16):1864-1866.
[40]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):后插2-后插42页.
[41]李斌,范源,李鑫.基于PI3K/Akt信号通路的中药治疗2型糖尿病胰岛素抵抗研究进展[J].中成药,2017,39(1):151-154.
[42]贺清珍,刘平侠,程艳荣,等.益气养阴方对气阴两虚证2型糖尿病患者血脂、糖代谢指标的影响[J].中国临床研究,2017,30(2):265-267.
[2]中华医学会内分泌学分会.中国2型糖尿病合并肥胖综合管理专家共识[J].中华内分泌代谢杂志,2016,32(8):623-627.
[3]张黎明,高凌.炎症细胞因子在2型糖尿病发病机制中的研究进展[J].重庆医学,2016,45(8):1113-1116.
[4]张静,吕毅.肠道菌群失调诱发2型糖尿病的研究进展[J].中国微生态学杂志,2016,28(1):113-116.
[5]Gao HX,Regier EE,Close KL.International Diabetes Federation World Diabetes Congress 2015[J].J Diabetes,2016,8(3):300-302.
[6]李景琴.2型糖尿病中医证型流行病学调查及其中医病因病机初探[J].饮食保健,2018,5(10):248-249.
[7]吴嘉瑞,王凯欢,纪凯,等.基于数据挖掘的中医治疗糖尿病处方用药规律分析[J].中国实验方剂学杂志,2015,21(22):214-217.
[8]王金梅,郭俊杰.中医药治疗2型糖尿病胰岛素抵抗研究进展[J].世界中西医结合杂志,2017,12(11):1624-1628.
[9]王丽芹,李振南,隋博文.2型糖尿病的中医药研究进展[J].中医药信息,2017,34(3):121-124.
[10]国家食品药品监督管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:234.
[11]Higgins JPT,Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[S/OL][updated March 2011].http://handbook-5-1.cochrane.org/.
[12]Chen B,Benedetti A.Quantifying heterogeneity in individual participant data meta-analysis with binary outcomes[J].Syst Rev,2017,6(1):243.
[13]Sterne JA,Egger M.Funnel plots for detecting bias in meta-analysis:guidelines on choice of axis[J].J Clin Epidemiol,2001,54(10):1046-1055.
[14]江丹,罗露露,汪何.三芪丹颗粒治疗2型糖尿病合并高血压病的临床观察[J].中国中西医结合杂志,2009,29(8):737-739.
[15]饶线明,李亚林.益气养阴法治疗气阴两虚型糖尿病30例[J].福建中医药,2009,40(4):22-23.
[16]陈常云,陈君,房经富,等.中西医结合治疗糖尿病临床研究[J].中医学报,2015,30(11):1590-1592.
[17]宋杰,胡阳黔,刘坚,等.黄芪多糖对糖尿病大鼠血游离脂肪酸水平的影响及其机制[J].中国医药,2014,9(10):1475-1479.
[18]王荣欣,马建华.中西医结合治疗早期糖尿病肾病40例临床研究[J].江苏中医药,2005,26(1):14-16.
[19]李春桂,苗桂珍,朱学敏.益气养阴清热活血法治疗早期糖尿病肾病33例临床观察[J].河北中医,2009,31(8):1133-1135.
[20]王光明,王志高.益气养阴、活血通络法治疗早期糖尿病肾病63例[J].甘肃中医,2009,50(6):24-26.
[21]漆军华.中西医结合治疗气阴两虚型2型糖尿病临床观察[J].广西中医药,2011,34(2):16-17.
[22]王玉红.益气养阴汤联合二甲双胍片治疗2型糖尿病60例临床研究[J].河北中医,2012,34(8):1175-1177.
[23]闫玲玲,马建.祛胰抵方对2型糖尿病IR的临床观察[J].中医药学报,2012,40(1):113-115.
[24]蔡恩丽,武煜明,刘明星,等.自拟益气养阴活血汤治疗气阴两虚型糖尿病肾病60例疗效观察[J].云南中医中药杂志,2013,34(6):26-27.
[25]马婕.益气养阴清热活血法治疗早期糖尿病肾病的疗效及对血液流变学的影响[J].吉林中医药,2014,34(12):1225-1228.
[26]张国琼,尤强,吕蒙,等.益气养阴活血汤治疗2型糖尿病36例报告[J].糖尿病新世界,2014(19):35-36.
[27]胡仁明,谢颖,鹿斌,等.2型糖尿病患者高发“代谢性炎症综合征”[J].中华内分泌代谢杂志,2016,32(1):27-32.
[28]肖月星,闫秀峰,倪青,等.基于中医个体化诊疗平台和无尺度网络的2型糖尿病中药性味网络分布特征分析[J].天津中医药大学学报,2017,36(2):107-112.
[29]张怀民,傅秀慧,郑海洲.中药活性成分治疗2型糖尿病及其并发症作用机制的研究进展[J].中国药房,2016,27(22):3151-3153.
[30]Gu C,Zeng Y,Tang Z,et al.Astragalus polysaccharides affect insulin resistance by regulating the hepatic SIRT1-PGC-1α/PPARα-FGF21 signaling pathway in male Sprague Dawley rats undergoing catch-up growth[J].Mol Med Rep,2015,12(5):6451-6460.
[31]Shieh JP,Cheng KC,Chung HH,et al.Plasma glucose lowering mechanisms of catalpol,an active principle from roots of Rehmannia glutinosa,in streptozotocin-induced diabetic rats[J].J Agric Food Chem,2011,59(8):3747-3753.
[32]Hsu JH,Wu YC,Liu IM,et al.Dioscorea as the principal herb of Die-Huang-Wan,a widely used herbal mixture in China,for improvement of insulin resistance in fructose-rich chow-fed rats[J].J Ethnopharmacol,2007,112(3):577-584.
[33]马丽娜,毛新民,马晓丽,李琳琳,王烨,陶义存,王敬伟,郭佳佳,兰怡.蛋白干预对气阴两虚2型糖尿病大鼠氨基酸代谢谱的影响[J].中国中药杂志,2016,41(22):4226-4233.
[34]Stolar M.Glycemic control and complications in type 2 diabetes mellitus[J].Am J Med,2010,123(3):S3-11.
[35]Kohnert KD,Augstein P,Zander E,et al.Glycemic variability correlates strongly with postprandial beta-cell dysfunction in a segment of type 2 diabetic patients using oral hypoglycemic agents[J].Diabetes Care,2009,32(6):1058-1062.
[36]Patel A,Mac Mahon S,Chalmers J,et al.Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes[J].NEngl J Med,2008,358(24):2560-2572.
[37]李艳彬.2型糖尿病患者中医药治疗与血管并发症风险的相关性研究[J].保健文汇,2019,9(1):179.
[38]王金梅,郭俊杰.中医药治疗2型糖尿病胰岛素抵抗研究进展[J].世界中西医结合杂志,2017,12(11):588-589.
[39]张淑芳,吕树泉,苏秀海.2型糖尿病大血管病变中医药研究进展[J].中西医结合心脑血管病杂志,2016,14(16):1864-1866.
[40]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):后插2-后插42页.
[41]李斌,范源,李鑫.基于PI3K/Akt信号通路的中药治疗2型糖尿病胰岛素抵抗研究进展[J].中成药,2017,39(1):151-154.
[42]贺清珍,刘平侠,程艳荣,等.益气养阴方对气阴两虚证2型糖尿病患者血脂、糖代谢指标的影响[J].中国临床研究,2017,30(2):265-267.