维生素D治疗2型糖尿病肾病疗效的系统评价

发布时间：2018-12-11 00:01

【摘要】：目的:国内外糖尿病患病率及发病率不断升高,糖尿病肾病是其重要并发症,严重影响公众健康及经济负担,但目前药物对糖尿病肾病疗效不明确,为找到对糖尿病肾病安全有效的治疗方法,我们对维生素D(Vitamin D VD)治疗2型糖尿病肾病进行系统评价。方法:计算机检索“Pub Med、MEDLINE、CBM、CNKI”等数据库及手工检索1950年1月至2014年5月的相关文献。根据纳入标准及排除标准筛选维生素D对2型糖尿病肾病疗效的随机对照试验(Randomized controlled trials RCT),由两名评价员独立对纳入的文献进行质量评价和提取相关数据,包括尿蛋白定量、血肌酐、肾小球滤过率、超敏C反应蛋白、血钙浓度及不良反应。该系统分析为计量资料,采用X2检验进行异质性检验,用Rev Man5.0软件进行Meta分析,当P值大于0.05采用固定效应模型,小于0.05进行亚组分析并采用随机效应模型。结果:最终纳入15项随机对照试验,共计1036例患者,其中治疗组522例,对照组512例。根据Cochrane评价手册对纳入文献进行3个等级评价,其中1篇A级、1篇B级、13篇C级。Meta分析结果示:VD治疗2型糖尿病肾病治疗组与对照组比较,可分别减少2-3个月及6个月24小时尿蛋白定量(0.37%P=0.005)、(0.2%P0.00001),可降低超敏-C反应蛋白(hs-CRP)(0.79%P0.00001),可升高6个月血钙浓度,但对血肌酐的影响无明显差异。8篇文献报道了VD治疗的不良反应,其中1篇发生高钙血症。结论:VD对2型糖尿病肾病有一定的疗效,但因现有RCT研究质量尚不够高,故我们应慎重对待本论文的结论,尚需要更多高质量的RCT才能得出肯定结论。
[Abstract]:Objective: the prevalence and incidence of diabetes mellitus are increasing at home and abroad. Diabetic nephropathy is an important complication of diabetic nephropathy, which seriously affects public health and economic burden. However, the curative effect of drugs on diabetic nephropathy is not clear at present. In order to find a safe and effective treatment for diabetic nephropathy, we systematically evaluated the treatment of type 2 diabetic nephropathy with vitamin D (Vitamin D VD). Methods: Pub Med,MEDLINE,CBM,CNKI and other databases were searched by computer and related documents from January 1950 to May 2014 were searched manually. A randomized controlled trial (Randomized controlled trials RCT),) to screen the efficacy of vitamin D in the treatment of type 2 diabetic nephropathy according to the inclusion criteria and exclusion criteria was conducted by two evaluators to evaluate the quality of the literature included and to extract relevant data, including urine protein quantification. Serum creatinine, glomerular filtration rate, hypersensitive C reactive protein, serum calcium concentration and adverse reactions. X2 test was used for heterogeneity test and Rev Man5.0 software was used for Meta analysis. When P value was greater than 0. 05, fixed effect model was used, subgroup analysis was performed under 0. 05 and random effect model was used. Results: a total of 1036 patients were included in 15 randomized controlled trials, including 522 cases in the treatment group and 512 cases in the control group. According to the Cochrane evaluation manual, three grades of literature were evaluated, including one A, one B, 13 C. The results of Meta analysis showed that the treatment group of type 2 diabetic nephropathy treated with VD was compared with the control group. Urinary protein quantification (0.37%P=0.005), (0.2%P0.00001) and hypersensitive C-reactive protein (0.79%P0.00001) were reduced by 2-3 months and 6 months, respectively. The serum calcium concentration was increased for 6 months, but there was no significant difference in the effect of serum creatinine. The adverse reactions of VD treatment were reported in 8 articles, one of which developed hypercalcemia. Conclusion: VD has a certain curative effect on type 2 diabetic nephropathy, but the quality of existing RCT research is not high enough, so we should treat the conclusion of this paper with caution and need more high quality RCT in order to reach a positive conclusion.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2

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