ACEI与ARB联合治疗临床糖尿病肾病的疗效与安全性的Meta分析

摘要

Objective:To evaluate the efficacy and safety of combined treatment with angiotensin Ⅱ receptor blocker (ARB) and angiotensin converting enzyme inhibitor (ACEI) on diabetic kidney disease.Methods:Randomized controlled trials (RCTs) were identified from CoChrane library,PubMed,EMbase,CNKI and VIP.Eleven RCTs involving 602 patients were included and analyzed with Rev Man 5.1 software.Results:Compared with ACEI alone,combined treatment with ARB and ACEI was more effective on decreasing 24 h albuminuria,systolic pressure,average 24 h systolic pressure,diastolic pressure,and average 24 h diastolic pressure but with a high 0evel of serum potassium.Compared with ARB alone,combined treatment with ARB and ACEI was more effective on decreasing systolic pressure and diastolic pressure.Compared with ACEI or ARB alone,we didn't get a definite conclusion that whether combined treatment with ARB and ACEI was more effective on decreasing 24 h proteinuria.Conclusion:Based on this Meta analysis,combined treatment with ARB and ACEI is safer and has positive effect on diabetic kidney disease.However,small sample size and low methodological quality appeared in most of the trials included in this systematic review.Therefore,available evidence is insufficient to recommend a routine clinical application of combined treatment with ARB and ACEI on diabetic kidney disease.%目的:系统评价血管紧张素转化酶抑制剂(ACEI)与血管紧张素Ⅱ受体拮抗剂(ARB)联合治疗临床糖尿病肾病的疗效与安全性.方法:计算机检索CoChrane图书馆、PubMed、Embase、中国期刊全文数据库、维普资讯网.采用Revman 5.1软件对11篇随机对照试验(RCTs)的602例患者进行Meta分析.结果:与单用ACEI相比,ACEI与ARB联合用药组的24h尿白蛋白、收缩压、24h平均收缩压、舒张压、24h平均舒张压均明显下降;血钾明显升高.与单用ARB类药物相比,ACEI与ARB联合用药组的收缩压、舒张压明显下降.与单用ACEI或ARB相比,ACEI与ARB联合用药对降低临床糖尿病肾病患者的24h尿白蛋白的疗效尚存在分歧,不能得出明确结论.结论:ACEI与ARB联合治疗临床糖尿病肾病有一定的疗效且相对安全.但由于本系统评价纳入的试验样本量较小且方法学质量偏低,现有证据不足以推荐临床常规应用ACEI与ARB联合治疗临床糖尿病肾病.