骨化三醇治疗糖尿病肾病的Meta分析

发布时间：2018-02-24 20:37

本文关键词： 骨化三醇糖尿病肾病 ACEI ARB 维生素D　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究通过对国内外有关骨化三醇联合血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)治疗糖尿病肾病的临床随机对照实验进行meta分析,探讨在骨化三醇在联合ACEI或ARB药物基础上治疗糖尿病肾病的有效性和安全性。方法:对Cochrane图书馆临床对照试验资料库、PUBMED、万方数据库、维普期刊数据库、CNKI数据库、CBM网络版数据库等自建库以来至2017年1月的所有中英文文献进行检索,根据预先设定的纳入与排除标准筛选出完全符合标准的临床随机对照试验,对所纳入标准的文献提取信息,提取内容包括:文献作者及发表时间,随机方法,研究对象的基本资料,施加干预措施、剂量、疗程和结局观察指标,不良反应等。运用修改后的Jadad量表对纳入文献进行评分,应用Revman5.2统计软件对所检出文献中提取的数据进行Meta分析。结果:经过检索及严格筛选文献,最终纳入标准临床随机对照试验23个,包括1732例患者,其中实验组867例,对照组865例。Meta分析结果显示与单独使用ACEI或ARB药物治疗糖尿病肾病相比,骨化三醇联合ACEI或ARB药物治疗可显著降低24小时尿蛋白[P0.00001,MD=-0.43,95%CI(-0.50,-0.35)]及尿微量白蛋白[P0.00001,MD=-36.94,95%CI(-39.08,-34.80)],但可能使血磷水平增高[P=0.02,MD=0.03,95%CI(0.00,0.06)],对患者血钙[P=0.79,MD=0,95%CI(-0.03,-0.04)],血钾[P=0.19,MD=-0.06,95%CI(-0.14,-0.03)],收缩压[P=0.22,MD=-1.55,95%CI(-4.03,0.93)]及舒张压[P=0.37,MD=-0.71,95%CI(-2.25,0.83)]无明显影响;联合治疗方案不增加不良反应的发生率[P=0.71,OR=0.87,95%CI(0.43,1.77)]。结论:与单独使用ACEI或ARB治疗糖尿病肾病相比,联合骨化三醇治疗糖尿病肾病降低24小时尿蛋白及尿微量白蛋白效果更显著,但可能使血磷水平升高,对血钙、血钾影响无明显差异,对血压(收缩压及舒张压)控制水平无明显影响,不增加不良反应发生率。由于各临床随机对照试验中入选患者间差异,以及应用骨化三醇剂量、疗程等存在差异,结果尚需大规模、多中心、前瞻性随机对照试验加以证实。
[Abstract]:Objective: in this study, meta analysis was carried out in the randomized controlled trials at home and abroad on the treatment of diabetic nephropathy with oscitic triol combined with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (Angiotensin receptor antagonist). Objective: to investigate the efficacy and safety of ossifying triol in the treatment of diabetic nephropathy on the basis of combination of ACEI or ARB. Methods: the clinical controlled trial database of Cochrane library was used. All the literatures in Chinese and English have been searched since the establishment of CNKI database and CBM online database until January 2017. According to the pre-set inclusion and exclusion criteria, the clinical randomized controlled trials were screened out. The information extracted from the standard literature included: the author and the time of publication, the random method, the basic information of the study object, the intervention measures, the dose, the course of treatment and the outcome observation index. Adverse reactions and so on. Using the revised Jadad scale to score the included documents, Revman5.2 statistical software was used to analyze the data extracted from the detected documents by Meta. Results: after retrieval and strict screening of the literature, Included in the standard randomized controlled trial of 23, including 1 732 patients, including 867 patients in the experimental group, 865 patients in the control group. Meta-analysis results showed that compared with the treatment of diabetic nephropathy with ACEI or ARB alone. Ossifying triol combined with ACEI or ARB could significantly decrease 24 hour urinary protein (P0.00001MD-0.43CI-95CI-0.50 ~ 0.35) and urine microalbuminuria [P0.00001MD-36.94995 CI-39.08-34.80], but could increase blood phosphorus level [P0.02MD0.0395CI 0.000.06], but had no effect on serum calcium [P0.7001MD095CI-0.03CI-0.04], serum potassium [P0.19MD-0.06CI-0.03CI-0.14C]. The combined therapy did not increase the incidence of adverse reactions [P < 0.71] .Conclusion: compared with ACEI or ARB alone in the treatment of diabetic nephropathy, the effect of combined ossification triol in the treatment of diabetic nephropathy was significantly lower than that in the treatment of diabetic nephropathy with 24 hours urinary protein and urinary microalbuminuria. But it may increase the level of blood phosphorus, have no obvious difference on the effect of blood calcium and potassium, and have no obvious effect on the control level of blood pressure (systolic blood pressure and diastolic pressure). There was no increase in the incidence of adverse reactions. Due to the differences among the selected patients in each clinical randomized controlled trial, as well as the difference in dosage and course of treatment, the results need to be confirmed in large scale, multi-center, prospective randomized controlled trials.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R692.9

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