安体舒通治疗糖尿病肾病的系统评价

Spironolactone for Diabetic Nephropathy:A Systematic Review

目的评价醛固酮受体拮抗剂安体舒通治疗糖尿病肾病的有效性及安全性。方法采用Cochrane系统评价方法,计算机检索Cochrane图书馆临床对照试验资料库(2008年第3期)、MEDLINE(1950～2008.8)、EMBASE(1984～2008.8)、CNKI(1994～2008.9)、VIP(1989～2008.8);手工检索相关会议论文集、药厂资料及所有检索到的文献的参考文献,纳入安体舒通治疗糖尿病肾病的随机或半随机试验,评价纳入研究的方法学质量,并提取有效数据进行分析。结果共纳入3篇随机对照试验,但3篇研究存在临床异质性,无法进行Meta分析,故仅进行描述性分析。RCT试验证实安体舒通对于减少尿蛋白可能有一定作用,但是对于改善肾功能和降低血压可能并无确切疗效。结论据现有研究尚不能证实安体舒通是否对糖尿病肾病患者有效和安全,需要今后有大样本、高质量的随机对照试验进一步证实。

Objective To evaluate the effectiveness and safety of spironolactone for diabetic nephropathy. Methods We electronically searched CENTRAL （issue 3, 2008）, MEDLINE （1950 to August 2008）, EMbase （1984 to August 2008）, CNKI （1994 to September 2008）, and VIP （1989 to August 2008）. We also checked the reference lists of all papers identified for further trials. Randomized controlled trials （RCTs） and quasi-RCTs were identified and analyzed according to the Cochrane Handbook for Systematic Reviews of Interventions. Results Three RCTs were included. Meta-analysis was not performed due to heterogeneity. Trials showed that spironolactone might decrease urinary albumin excretion, but could scarcely play an important role on kidney function and blood pressure. Conclusion Affirmative assessment cannot be made about the effectiveness and safety of spironolactone for diabetic nephropathy according to the limited existing trials. Large-scale, high-quality RCTs are needed to confirm or refuse the available evidence.