摘要
本文综合评价西尼地平和L-型钙通道阻滞剂(L-型CCB)对高血压患者肾脏功能的影响。我们采用了检索Pubmed、Embase、Google Scholar、CNKI、Science Direct、Ebsco、Springer、Ovid、Cochrane Library、Medline、维普和万方等数据库建库至2014年9月有关西尼地平和L-型CCB对肾脏功能影响的临床随机对照试验(RCT)文献。按Jadad质量标准对纳入文献进行独立评价并交叉核对,采用RevMan 5.3软件进行Meta分析。以血清肌酐值(SCr)、尿蛋白排泄量(UPE)、尿蛋白/肌酐比(UPCR)、估算的肾小球滤过率(eG FR)为指标,以用药前后指标变化百分率均数差值(mean difference,MD)及其95%可信区间(95%CI)进行综合评价。发现共纳入10篇质量较高RCT文献,采用随机效应或固定效应模型分析,结果显示:治疗后,西尼地平组较L-型CCB组更明显降低UPE,二者对UPE影响有显著区别(MD=–36.59,95%CI:–70.85,–2.33),西尼地平组较L-型CCB组更明显降低UPCR,二者对UPCR影响有显著区别(MD=–46.56,95%CI:–88.50,–4.62);而对SCr(MD=0.01,95%CI:–2.97,2.98)及eG FR(MD=1.56,95%CI:–0.19,3.31)的影响二组间无显著差异。由此可知,与L-型CCB相比,西尼地平更能有效减少尿蛋白的排泄,延缓蛋白尿发展进程,而对SCr及eG FR影响方面,二组间无明显差异。
In the present study, we aimed to evaluate the effects of cilnidipine and L-type calcium channel blockers（L-type CCBs） on renal function in hypertensive patients. The randomized controlled trials（RCTs） of cilnidipine and L-type CCBs on hypertension treatment were selected from Pubmed, Embase, Google Scholar, CNKI, Science Direct, Ebsco, Springer, Ovid, Cochrane Library, Medline, VIP and Wanfang databases（from the date of databases＇ establishment to September 2014）. Data were independently evaluated following the Jadad standard. The percentage changes of serum creatinine（SCr） value, urinary protein excretion（UPE）, urinary protein/creatinine ratio（UPCR） and estimated glomerular filtration rate（e GFR） pre- and post-treatment were extracted for the subsequent meta-analysis. The mean difference（MD） and the 95% confidence interval（95% CI） were determined using RevM an 5.3 software. A total of 10 RCTs of high quality were included and analyzed by fixedor random-effect models. The results indicated that UPE（MD = –36.59, 95% CI： –70.85, –2.33） or UPCR（MD = –46.56, 95% CI： –88.50, –4.62） was significantly reduced by cilnidipine compared with L-type CCBs. However, such significant difference was not detected in reduction of SCr（MD = 0.01, 95% CI： –2.97, 2.98） or eG FR（MD = 1.56, 95% CI： –0.19, 3.31）. Compared with L-type CCBs, cilnidipine was more effective in reducing proteinuria or preventing the proteinuria progression. In addition, we did not find significant differences in SCr and eG FR between the two groups.
基金
Chongqing Municipal Commission of Health and Family Planning(Grant No.2015ZBXM005)
