ACEI影响血压正常的糖尿病人尿白蛋白分泌的荟萃分析

摘要/Abstract

摘要： 目的对血管紧张素转化酶抑制剂(ACEI)是否能有效抑制血压正常的糖尿病人的尿白蛋白分泌进行系统评价. 方法查阅自1980年1月至2004年3月期间发表的有关ACEI对血压正常的糖尿病人尿蛋白影响效应的随机对照临床试验研究文献.选择的检索数据库有:Medline(1980-2003), Embase数据库(Embase database)(1980-2000), Cochrane图书馆(Co-chrane Library, CL)(1980-2004), 中国生物医学文献数据库(CBMdisc)(1980-2002), 国际药学文献(IPA)(1980-2002).最终入选7项随机对照试验.采用Revman 4.2软件对试验结果进行合并分析.结果 7项试验治疗末期AER值与基线值差值的合并治疗效应为-56.31μg·min^-1 [-81.96, -30.66](P<0.0001), 具显著的统计学意义. 根据亚组分析结果, 治疗1-5年期AER值与基线值差值的合并治疗效应分别为-11.97μg·min^-1[-22.04, -1.89](P=0.02), -28.01μg·min^-1 [-34.50, -21.52](P<0.00001), -43.24μg·min^-1[-57.15, -29.32](P<0.00001), -61.25μg·min^-1 [-77.77, -45.54](P<0.00001), -98.41μg·min^-1 [-162.02, -34.79](P=0.002), 均有显著统计学意义.治疗末期由微量蛋白尿发展为临床蛋白尿的数据合并效应量PetoOR=0.27[0.18, 0.40](95%CI), P<0.00001, 具有显著的统计学意义.2年期, 5年期亚组合并效应量PetoOR=0.30[0.18, 0.51](P<0.00001), PetoOR=0.25[0.13, 0.50](P<0.0001), 均具有显著统计学意义.各分析结果发表偏倚影响均较小.结论对血压正常的早期糖尿病患者, ACEI有效降低了尿白蛋白的排泄率, 减缓了糖尿病人由微量蛋白尿发展为临床蛋白尿的进程.

关键词: 血管紧张素转化酶抑制剂ACEI, 血管紧张素转化酶抑制剂ACEI, 糖尿病, 糖尿病, 尿微量白蛋白, 尿微量白蛋白, 尿蛋白, 尿蛋白, Meta-分析, Meta-分析

Abstract: Aim To examine whether AER(albumin excretion rate) in normotensive diabetic patients can be effectively inhibited by ACEI. Methods Literature on randomized controlled trials of ACEI for inhibiting AER in normotensive dia-betic patients was searched. The electronic databases retrieved were Medline(1980-2003), Embase database (1980-2000), Cochrane Library, CL( 1980-2004), CBMdisc( 1980 - 2002), and IPA(1980-2002). Seven studies were chosen.Data were combined by Revman 4.2. Results The pooled effect of change in AER is -56.31 μg·min^-1 [-81.96, -30.66] (P<0.0001). According to the analysis of subgroups, the pooled effects of 1-5 years are -11.97μg·min^-1 [-22.04, -1.89](P = 0.02), -28.01 μg· min^-1[-34.50, -21.52](P<0.00001), -43.24 μg·min^-1[-57.15, -29.32] (P<0.00001), -61.65 μg·min^-1 [-77.77,-45.54] (P<0.00001), and -98.41 μg·min^-1 [-162.02,-34.79] ( P = 0.002). Regarding progression toclinincal proteinuria as end-point,the pooled Peto OR =0.27 [0.18,0.40] (95% CI), P<0.00001. According to the analysis of subgroups, the pooled effects of 2 and 5 years are Peto OR = 0.30 [0.18,0.51] (P<0.00001) and Peto OR=0.25 [0.13,0.50](P<0.0001). Publication bias is small. Conclusion In normotensive diabetic patients, ACEI inhibits AER effectively and reduces the probability of progression of microalbuminuria to clinical proteinuria.

Key words: Angiotensin-converting enzyme mhibitor, Angiotensin-converting enzyme mhibitor, diabetes mellitus, diabetes mellitus, microalbuminuria, microalbuminuria, urine protein, urine protein, meta-analysis, meta-analysis

中图分类号:

R911.2

R972.4

Supporting: ^*Corresponding author. Tel.: 010-62017691-2740

吴浩, 翟所迪^*, 卢荣枝. ACEI影响血压正常的糖尿病人尿白蛋白分泌的荟萃分析[J]. .

WU Hao, ZHAI Suo-di^*, LU Rong-zhi . Meta-analysis of the Use of ACEI for Inhibiting Albuminuria in Diabetic Patients[J]. .

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