抗高血压类药物治疗IgA肾病的Meta分析

Meta-analysis of Antihypertensive Agents in the Treatment of IgA Nephropathy

目的评价抗高血压类药物治疗IgA肾病(IgAN)的疗效和安全性。方法检索Cochrane图书馆、PubMed、EMBase、CBMdisc、中国知网(CNKI)、中文科技期刊全文数据库(VIP)等,检索时间均从建库至2012-05-31,由3名系统评价员进行资料提取和质量评价,对同质资料运用RevMan 5.0软件进行Meta分析。结果共纳入23项研究(n=1 504)。Meta分析结果示:血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)与安慰剂或无治疗比较,终末期肾病(ESRD)或肌酐倍增发生率〔OR=0.20,95%CI(0.08,0.51)〕及24 h尿蛋白定量〔MD=-0.77,95%CI(-1.04,-0.49)〕间差异有统计学意义(P<0.05);ACEI联合ARB与单药比较,联合用药组24 h尿蛋白定量〔MD=-0.50,95%CI(-0.70,-0.31)〕间差异有统计学意义(P<0.05);ARB与ACEI相比,ESRD发生率〔OR=2.01,95%CI(1.02,3.95)〕间差异有统计学意义(P<0.05);ARB或ACEI或联合用药与对症治疗相比,血清肌酐水平〔MD=-39.37,95%CI(-71.95,-6.80)〕、24 h尿蛋白定量〔MD=-1.16,95%CI(-1.52,-0.81)〕及血清内生肌酐清除率〔MD=19.10,95%CI(10.44,27.77)〕间差异有统计学意义(P<0.05);ARB联合糖皮质激素与糖皮质激素相比,24 h尿蛋白定量〔MD=-0.20,95%CI(-0.26,-0.14)〕间差异有统计学意义(P<0.05);ACEI联合β-受体阻滞剂与钙离子拮抗剂联合β-受体阻滞剂对比,24h尿蛋白定量〔MD=-0.54,95%CI(-0.83,-0.25)〕间差异有统计学意义(P<0.05)。结论现有的证据显示:ACEI和ARB均能降低IgAN患者的尿蛋白,但联合用药效果更佳,ARB的治疗效果至少不差于ACEI;抗高血压类药物能否改善IgAN患者的肾功能及预后尚不能得出明确的结论。

Objective To evaluate the efficacy and safety of antihypertensive agents in the treatment of IgA nephropathy.Methods We searched the Cochrane library,PubMed,EMBase,CBMdisc,CNKI,VIP for related articles published from the establishment of the database to 31 May 2012.Three reviewers assessed the quality of the searched studies and extracted data.RevMan 5.0 was used to conduct meta-analysis on homogenous studies.Results Twenty-three studies involving 1 504 participants were included.Incidence of end stage renal disease(ESRD)/doubled serum creatinine(OR=0.20,95%CI(0.08,0.51)) and 24-hour proteinuria(MD=-0.77,95%CI(-1.04,-0.49))were significantly different between angiotensin-converting enzyme inhibitor(ACEI)/ angiotensinⅡreceptor blocker(ARB) groups and placebo/no treatment groups(P<0.05).24-hour proteinuria(MD=-0.50,95%CI(-0.70,-0.31)) of ACEI+ARB group was significantly different from ARB or ACEI group(P<0.05).ESRD(OR=2.01,95%CI(1.02,3.95)) was significantly different between ACEI and ARB group(P<0.05).Serum creatinine level(MD=-39.37,95%CI(-71.95,-6.80)),24-hour proteinuria(MD=-1.16,95%CI(-1.52,-0.81)),and creatinine clearance(MD=19.10,95%CI(10.44,27.77)) were significantly different between ACEI/ARB/ACEI+ARB group and symptomatic treatment group(P<0.05).24-hour proteinuria(MD=-0.20,95%CI(-0.26,-0.14)) was significantly different between ARB+glucocorticoid group and glucocorticoid group(P<0.05).24-hour proteinuria(MD=-0.54,95%CI(-0.83,-0.25)) was also significantly different between ACEI+β-blocker group and calcium-channel blocker+β-blocker group(P<0.05).Conclusion Both ACEI and ARB can reduce proteinuria in patients with IgA nephropathy,and the combination of the two drugs has better effects.The therapeutic effect of ARB is at least no inferior to ACEI.It can not be concluded whether antihypertensive agents can improve the renal function and prognosis of patients with IgA nephropathy.