ACEI对血压正常的早期糖尿病肾病治疗作用的Meta分析

目的：对血管紧张素转换酶抑制剂（ＡＣＥＩ）能否延缓血压正常的早期糖尿病肾病（ｄｉａｂｅｔｉｃ ｎｅｐｈｒｏｐａｔｈｙ，ＤＮ）患者的病情进展进行系统评价。方法：检索ＭＥＤＬＩＮＥ及中国生物医学文献数据库中收录的１９９０年１月至１９９９年４月间，有关ＡＣＥＩ对伴微量白蛋白尿的早期ＤＮ治疗作用的随机对照临床试验方面的文献。按照入选标准，最终有１０项随机对照临床试验纳入本研究。用ＲｅｖＭａｎ３．１软件对１

A Meta-analysis of ACE-inhibitors on normotensive early diabetic renal disease

Objective: To examine whether the progression of early diabetic renal disease with normotension can be slowed by ACE inhibitors(ACEI). Methods: MEDLINE and Chinese Biological Medicine Disk were searched for randomized controlled trials about the effect of ACE inhibitors on patients with normotensive early diabetic renal disease from January, 1990 to April, 1999. According to included criteria, 10 studies were chosen at last.Data were combined by RevMan 3.1 software. Results: The pooled effect sizes of urinary microalbuminuria excretion rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were -77.502 mg/24 h-100.748,-54.256], -5.002 mmHg -9.630, -0.685 ], -2.949 mmHg-4.005, -1.892], -4.284 mmHg-5.444, -3.123] respectively. Regarded progression to clinical albuminuria as end point,the pooled OR(odds ratio) was 0.270.18,0.40]. The sub category analysis showed no differences between type 1 and type 2 diabetes.There were no significant correlations between the pooled effect of urinary microalbuminuria excretion rate and systolic blood pressure, diastolic blood pressure or mean arterial blood pressure. Conclusion: ACE inhibitors can decline urinary microalbuminuria excretion rate in patients with normotensive early diabetic renal disease and delay the progression of early diabetic renal disease to clinical albuminuria, and the effects may not depend on its blood pressure reduction effect.