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

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24h尿微量白蛋白排泄率、24h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。

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

AIM. To evaluate the clinical treatment effects on renal function of angioten- sin-converting enzyme inhibitors （ACEI） com bined with angiotensin Ⅱ receptor blocker （ARB） in patients with diabetic nephropathy （DN）. METHODS： Retrieve the domestic litera- tures 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 uri-nary albtamin excretion rate, 24-hour urine albu- min and 24 urinary protein were significantly im proved （〈0.05）. However, there was no sig nificant difference of serum creatinine, blood u rea 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 ere- atinine, 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.