摘要
目的系统评价依那普利联合厄贝沙坦治疗糖尿病肾病的疗效和安全性。方法通过Pubmed、Cochane Library、Embase、CNKI、维普等数据库检索有关依那普利联合厄贝沙坦治疗糖尿病肾病的文献,根据Revman软件上提供的偏倚风险评估工具评价文献质量,Rev Man5.3.1软件进行统计分析。结果共纳入12篇随机对照试验,其中英文文献2篇,中文文献10篇。Meta分析结果显示:依那普利联合厄贝沙坦治疗糖尿病肾病相较于常规治疗能够降低血清肌酐(MD=-11.98,95%CI:-22.80^-1.16,P=0.03),降低尿总蛋白(MD=-0.18,95%CI:-0.28^-0.08,P=0.0002),降低尿微量白蛋白(MD=-6.35,95%CI:-10.75^-1.94,P=0.005),降低收缩压(MD=-5.25,95%CI:-9.42^-1.08,P=0.01),降低舒张压(MD=-3.25,95%CI:-4.68^-1.81,P<0.00001),降低血钾(MD=0.09,95%CI:0.04~0.15,P=0.00009),而内生肌酐清除率、尿蛋白排泄率、肾小球滤过率、血糖、血尿素氮、血浆白蛋白、血清总胆固醇、不良反应等指标联合组与对照组比较差异无统计学意义(P>0.05)。结论依那普利联合厄贝沙坦治疗糖尿病肾病保护肾功能优于常规治疗,但与血糖、不良反应等预后结局的关系尚不明确,且纳入文献质量中等,因此有必要开展此方面的高质量、大样本、多中心的随机对照试验。
Objective To explore the clinical efficacy and safety of Enalapril Combined with irbesartan in the treatment of patients with diabetic nephropathy.nethods Randomized controlled trials （RCT） on the clinical efficacy and safety of Enalapril Combined with irbesartan for diabetic nephropathy were reviewed from Pubmed, Cochane Library , Embase, CNKI and VIP, from the earliest published articles to November 2016, all reviewed literatures were accessed by Modified Jadad quality scale. Statistic data was analysed by Rev Man5.3.1. Results This review contains 12 RCT studies（ 2 English literature, 10 Chinese literatures ）, including 1172 diabetic nephropathy patients with the treatment of Enalapril Combined with irbesartan. The meta-analysis indicated that compared with conventional therapies alone, Enalapril Combined with irbesartan could reduce serum creatinine （MD=-11.98,95% CI：-22.80-1.16,P=0.03）, decrease the 24-hour urine protein（MD=-0.18,95%CI：-0.28^-0.08, P=0.0002）and urine microalbumin（MD=-6.35,95% CI：-10.75^-1.94,P=-0.005）,reduce the systolic blood pressure （MD=-5.25,95% CI：-9.42^-1.08,P=-0.01）and diastolic blood pressure （MD=-3.25,95%CI：-4.68N-1.81 ,P〈0.00001 ）, decrease the serum potassium（MD=0.09,95% CI：0.04-0.15,P=0.00009）. However, there were no significant statistical differences on the endogenous creatinine clearance rate, Urinary Albumin Excretion Rate, glomerular filtration rate, blood glucose, Blood urea nitrogen, blood plasma albumin, serum total cholesterol, adverse reaction between the treatment groups and the control groups （P〉0.05）. Conclusion Enalapril Combined with irbesartan appears to have satisfactory efficacy and safety in the treatment of patients with diabetic nephropathy, which is superior to any conventional treatment. However, a clinical recommendation is not warranted due to the small number of studies included and moderate methodology quality. Multi-center and high-quality RCTs with large sample sizes are needed to provide stronger ev
出处
《基层医学论坛》
2017年第16期2017-2020,共4页
The Medical Forum
基金
四川省科技厅-泸州市-泸州医学院共建课题(14JC0070)
泸州市-泸州医学院共建课题(2013LZLY-J35)
