Meta-analysis Of Buyang Huanwu Decoction And Its Modified Formula Combined With Western Medicine In The Treatment Of Diabetic Kidney Disease

Objective:To systematically evaluate the efficacy and safety of Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic nephropathy by Meta-analysis.Methods:Search CNKI Database,Wan Fang Database,VIP database,Sino Med database,Cochrane Library,Pub Med and EMBASE were comprehensively searched by computer.The retrieval time is from the establishment of the database to November 01,2021,Chinese search terms mainly include"Buyang Huanwu Decoction","diabetic kidney disease","randomized control",etc.The main English search terms are"Buyang Huanwu decoction","diabetic kidney disease","randomized controlled trial",etc.Retrieved the clinical randomized controlled trial literature of Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease,extract and summarize the required data into an Excel table and Meta-analysis of the data by Rev Man 5.4.Results:1.According to the search strategy,a total of 437 research literatures were obtained by searching domestic and foreign databases.After screening by inclusion and ranking criteria,28 literatures were included in this study,and a total of 2554 patients were included.There were 1282 cases in Buyang Huanwu Decoction and its modified formula combined with western medicine（experimental）group and 1272 cases in pure western medicine treatment（control）group.The minimum sample size was 60 cases,and the maximum sample size was 198 cases.2.Meta-analysis results of Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic nephropathy:A total of 13 outcome indicators were analyzed.（1）Total effective rate:A total of 23 literature studies were included,and2234 cases were included.After testing,I2=25%,RR=1.32,95%CI[1.27,1.38],Z=12.70,P<0.00001,the results were statistically significant The total effective rate of Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease patients is significantly better than that of western medicine alone;（2）24h urinary protein quantification:A total of 14 literature studies were included,including 1217 cases.The test I2=85%,P<0.00001,the heterogeneity is large.After subgroup analysis and the subgroup analysis shows that the homogeneity of each subgroup is better,I2<50%,the result was statistically significant（P<0.00001）,indicating that Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease patients were better than western medicine alone in reducing the quantitative level of 24h urine protein;（3）Scr:A total of 7 literature studies were included,and 504 cases were included.After testing,I2=89%,P<0.00001,and the heterogeneity was large.According to subgroup analysis,the homogeneity of each subgroup was better,I2=0%,the results showed that when the Scr was within the normal range,there was no significant difference between Buyang Huanwu Decoction and its modified formula combined with western medicine and western medicine alone in reducing the Scr level in patients with diabetic kidney disease（P=0.82）.Above 133μmol/L,when the renal function is in the stage of damage,Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease patients are more effective in reducing Scr level than western medicine alone（P<0.00001）;（4）Glycated hemoglobin:A total of 8 literature studies were included,and678 cases were included.After testing,I2=77%,P<0.00001,and the heterogeneity was large.When one study was excluded,there was no heterogeneity within the group,and I2=0,MD=-0.13,95%CI[-0.18,-0.08],Z=5.38,P<0.00001,the results are statistically significant,indicating that Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease patients can reduce the The level of glycosylated hemoglobin is better than that of pure western medicine;（5）Fibrinogen:A total of 6 literature studies were included,and 652 cases were included.The test I2=85%,P<0.00001,the heterogeneity is large.After subgroup analysis and the subgroup analysis shows that the homogeneity of each subgroup is better,I2=0%,the results were statistically significant（P<0.00001）,indicating that Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease patients were better than western medicine alone in improving the level of fibrinogen;（6）Whole blood high shear viscosity:A total of 6 literature studies were included,including 600 cases.The test I2=85%,P<0.00001,the heterogeneity is large.After subgroup analysis and the subgroup analysis shows that the homogeneity of each subgroup is better,I2<50%,the result was statistically significant（P<0.00001）,indicating that Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease patients were better than western medicine alone in improving the high shear viscosity level of whole blood;（7）Whole blood low shear viscosity:6 literature studies were included and 600 cases were included.After testing,I2=94%,P<0.00001,and the heterogeneity was large.After subgroup analysis and the subgroup analysis showed that the homogeneity of each subgroup was better.I2<50%,the result was statistically significant（P<0.00001）,indicating that Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease patients were better than western medicine alone in improving the level of whole blood low shear viscosity;（8）Urinary albumin excretion rate,FBG,TC,TG,HDL index,after testing,have high heterogeneity.Subgroup analysis and sensitivity analysis failed to find the source of heterogeneity,and only descriptive analysis could be performed,so no reliable conclusion could be drawn.（9）Adverse reaction analysis:Among the 28 included literatures,only 3literatures mentioned adverse reactions,which manifested as dry cough,dizziness,lower blood pressure,abdominal distension,hypoglycemia,etc.No dangerous adverse events were reported.Look,its security is better.3.Literature quality evaluation.The quality of the included 28 research literatures was evaluated,and it was found that the overall quality of the literature was low.Most of the studies did not explain the randomization method,allocation concealment,and whether to use single-blind or double-blind implementation,resulting in a low overall level of evidence,which would affect the system.The authenticity and reliability of the evaluation.Conclusion:1.Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease can improve the total clinical effective rate,reduce 24h urine protein quantification,HBA_1c,improve fibrinogen,whole blood high shear viscosity and whole blood low shear viscosity.All aspects are better than those of the group using only western medicine;2.When the Scr was within the normal range,there was no significant difference between Buyang Huanwu Decoction and its modified formula combined with western medicine and simple western medicine in reducing the Scr level in patients with diabetic kidney disease;When the Scr was higher than the normal range,the kidney function is impaired,Buyang Huanwu Decoction and its modified formula combined with western medicine had better effect than the western medicine group in reducing Scr level in patients with diabetic kidney disease;3.Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease,in terms of improving urinary albumin excretion rate,fasting blood glucose,blood lipid levels（TC,TG,HDL）,due to the large heterogeneity of the combined results,no reliable conclusions can be drawn;4.Only a few studies of Buyang Huanwu Decoction and its modified formula combined with western medicine in the treatment of diabetic kidney disease mentioned adverse reactions,and no serious adverse events were reported.Only one study showed that the effect of reducing adverse reactions was better than that of the western medicine group alone.