血管紧张素转换酶抑制剂联合血管紧张素II受体拮抗剂对糖尿病肾病肾功能临床疗效的Meta分析

中国临床药理学与治疗学 ›› 2012, Vol. 17 ›› Issue (11): 1257-1262.

血管紧张素转换酶抑制剂联合血管紧张素II受体拮抗剂对糖尿病肾病肾功能临床疗效的Meta分析

韩素芳

浙江省绍兴文理学院附属医院老年病科,绍兴 312000,浙江

收稿日期:2012-04-20 修回日期:2012-07-03 出版日期:2012-11-26 发布日期:2012-12-04
作者简介:韩素芳,女,硕士研究生,主治医师,主要从事老年病研究。Tel: 0575-88619853 E-mail: jnhansufang1976@163.com

Meta-Analysis of ACEI combined with ARB on the effect of renal function with Diabetic Nephropathy

HAN Su-fang

Department of Geriatric, the Affiliated Hospital of Shaoxing University, Shaoxing 312000, Zhejiang, China

Received:2012-04-20 Revised:2012-07-03 Online:2012-11-26 Published:2012-12-04

摘要/Abstract

摘要： 目的: 评价血管紧张素转换酶抑制剂 (ACEI) 联合血管紧张素II受体拮抗剂 (ARB) 对糖尿病肾病肾功能的临床治疗效应。方法: 检索1990年1 月至2012年3月期间,国内公开发表的有关ACEI 或ARB联合及单独用药对治疗糖尿病肾病的随机对照临床试验研究文献,分析符合纳入标准的文献中有关肾功能疗效指标,并对其药物治疗前后的差值进行Meta 分析。结果: 共12项文献,包括900例糖尿病肾病患者纳入研究。Meta 分析显示,与ACEI 或ARB单独治疗组的肾功能指标相比,联合治疗组患者的 24 h 尿微量白蛋白排泄率、24 h 尿微量白蛋白和24尿蛋白定量的标准化均数合并效应量均有明显的改善 (P<0.05),而单药组和联合用药组之间的血肌酐、尿素氮和电解质则无明显改变。结论: ACEI 联合ARB治疗较单独用药治疗能明显改善糖尿病肾病患者尿蛋白的滤过作用,期待更多高质量的随机双盲对照试验提供高质量的证据。

关键词: 糖尿病肾病, 血管紧张素转化酶抑制剂, 血管紧张素П受体拮抗剂;, 肾功能, Meta 分析

Abstract: AIM: To evaluate the clinical treatment effects on renal function of angiotensin-converting enzyme inhibitors (ACEI) combined with angiotensin II receptor blocker (ARB) in patients with diabetic nephropathy (DN). METHODS: Retrieve the domestic literatures for the randomized controlled clinical trials about ACEI/ARB combined or mono-therapy on renal function in DN patients during the period January 1990 to March 2012.The difference of indicators for the renal function before and after treatment for the included literaturs was carried out RevMan 5.0 software. RESULTS: Total of 12 studies, including 900 cases of patients with DN, were included in this study. Meta-analysis showed that compared with ACEI or ARB mono-therapy, the combined treatment affection on the standardized mean difference for 24-hour urinary albumin excretion rate, 24-hour urine albumin and 24 urinary protein were significantly improved (P<0.05). However, there was no significant difference of serum creatinine, blood urea nitrogen and electrolytes between two groups.CONCLUSION: Compared with mono-therapy, ACEI and ARB combined treatment could exert anti-proteinuria effects in patients with DN, but no improvement on the serum creatinine, blood urea nitrogen and electrolytes. However, further large-scale trials are required to define the role of ACEI and ARB combined treatment in patients with DN.

Key words: Diabetic nephropathy, ACEI, ARB, Renal function, Meta- analysis

中图分类号:

R277.592

韩素芳. 血管紧张素转换酶抑制剂联合血管紧张素II受体拮抗剂对糖尿病肾病肾功能临床疗效的Meta分析[J]. 中国临床药理学与治疗学, 2012, 17(11): 1257-1262.

HAN Su-fang. Meta-Analysis of ACEI combined with ARB on the effect of renal function with Diabetic Nephropathy[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2012, 17(11): 1257-1262.

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