活性维生素D治疗糖尿病肾病的有效性和安全性系统回顾

发布时间：2018-12-17 11:06

【摘要】：目的:本研究通过对国内外有关活性维生素D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)治疗糖尿病肾病的随机对照实验进行系统回顾和meta分析,探讨在ACEI或ARB治疗糖尿病肾病基础上联用活性维生素D的有效性和安全性。方法:应用Cochrane系统评价方法,对Cochrane对照试验注册数据库、PUBMED、EMBASE、中国生物医学文献数据库(CBM)、相关期刊论文(CNKI)、维普(VIP)、万方(Wanfang)自建库以来至2015年1月的所有文献进行检索。文献语种为中文和英文。检索出完全符合制定的纳入标准的随机对照试验并对其进行质量评价,并使用Revman 5.12统计软件对从文献提取出的数据进行Meta分析。结果:经过检索及严格筛选文献,最终8个随机对照实验、共794例患者符合纳入标准进行meta分析研究,结果显示:与单纯使用ACEI/ARB组相比,ACEI/ARB联合活性维生素D组显著降低24小时尿蛋白[RR=-0.66,95%CI(-0.87,-0.46),P0.0001],但对糖化血红蛋白(Hb A1c)[RR=-0.01,95%CI(-0.08,0.06),P=0.78]无影响;联用活性维生素D治疗不增加不良事件发生率[OR=1.28,95%CI(0.72,2.27),P=0.41]。结论:与单纯使用ACEI或者ARB药物相比,联合使用活性维生素D能进一步降低糖尿病肾病患者的24小时尿蛋白,且不增加不良反应。该结果尚需大规模、多中心、前瞻性随机对照试验加以证实。
[Abstract]:Objective: to study the effects of active vitamin D combined with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB) on diabetic nephropathy. To investigate the efficacy and safety of ACEI or ARB combined with active vitamin D in the treatment of diabetic nephropathy. Methods: using Cochrane system evaluation method, registered database of Cochrane controlled trials, PUBMED,EMBASE, database of Chinese biomedical literature, (CBM), full text database of Chinese periodicals, (CNKI), Weip (VIP), were used. Wanfang (Wanfang) has searched all the literatures since it was built up to January 2015. The languages of the literature are Chinese and English. A randomized controlled trial with complete compliance with the inclusion criteria was retrieved and its quality was evaluated, and the data extracted from the literature were analyzed by Meta using Revman 5.12 statistical software. Results: a total of 794 patients met the inclusion criteria for meta analysis in 8 randomized controlled trials after searching and screening the literature. The results showed that: compared with the ACEI/ARB group alone, 794 patients met the inclusion criteria. ACEI/ARB combined with active vitamin D significantly decreased 24 hour urinary protein [RR=-0.66,95%CI (-0.87- 0.46), P 0.0001], but the glycosylated hemoglobin (Hb A _ 1c) [RR=-0.01,95%CI (-0.08 ~ 0.06)], There was no effect on P0. 78; Combined use of active vitamin D did not increase the incidence of adverse events [OR=1.28,95%CI (0.72 卤2.27), P < 0.41]. Conclusion: compared with ACEI or ARB alone, combined use of active vitamin D can further reduce 24 hour urine protein in patients with diabetic nephropathy without increasing adverse reactions. The results need to be confirmed by a large-scale, multi-center, prospective randomized controlled trial.
【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;R692.9

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