Combination of Astragalus membranaceus and Panax notoginseng as Main Components in the Treatment of Diabetic Nephropathy: A Systematic Review and Meta-Analysis

OBJECTIVE: This meta-analysis evaluated the curative effect of the compatibility of Astragalus membranaceus and Panax notoginseng (ARPN) as main components on diabetic nephropathy. METHODS: We used various Chinese and English databases, including the Cochrane Library, PubMed, Embase, Web of Science, the China National Knowledge Infrastructure (CNKI), China Biology Medicine Disc (SinoMed), VIP, and Wanfang, to search for randomized controlled trials on the compatibility of Astragalus membranaceus and Panax notoginseng as main components. After data extraction, meta-analysis was performed with Review Manager 5.4.0 and Stata 15, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to evaluate the quality of the evidence. RESULT: A total of 17 studies involving 1342 patients with diabetic nephropathy were included. Compared with the control group, ARPN can significantly improve the clinical effective rate of diabetic nephropathy (OR 5.12, 95% CI 3.42 to 7.66, P < 0.00001), and the curative effect of reducing UAER (MD −26.67, 95% CI −31.30 to −22.04, P < 0.00001) and 24 h urinary protein (SMD −0.58, 95% CI −0.75 to −0.41, P < 0.00001) is also significantly better than that of the control group, and it can also improve the renal function(Scr: MD −13.78, 95% CI −25.39 to −2.17, P=0.02; BUN: MD −0.74, 95% CI −1.27 to −0.20, P=0.007). In addition, it can also reduce glycosylated hemoglobin (SMD −1.30, 95% CI −2.33 to −0.27, P=0.01) and blood lipid(TC: SMD −0.62, 95% CI −0.95 to −0.29, P=0.0002; TG: SMD −0.47, 95% CI −0.75 to −0.19, P=0.0009; LDL: SMD −0.43, 95% CI −0.68 to −0.18, P=0.0008), and improve the TCM syndrome score (MD −4.87, 95% CI −6.17 to −3.57, P < 0.00001). Subgroup analysis suggested that the treatment plan of the control group could be the sources of heterogeneity. All the included studies had no obvious adverse effects. CONCLUSIONS: The compatibility of Radix Astragali and Radix notoginseng as the main components can effectively improve the renal function of patients with diabetic nephropathy and delay the progress of diabetic nephropathy. However, the results of this study need further research to be confirmed because of the uncertainty of the evidence and the suboptimal risk bias.