贝那普利联合厄贝沙坦治疗糖尿病肾病疗效的Meta分析

Clinical study of Benazepril combined with Irbesartan in the treatment of diabetic nephropathy

目的系统评价贝那普利联合厄贝沙坦治疗糖尿病肾病的临床效果。方法计算机检索建库至2016年11月国内外有关贝那普利联合厄贝沙坦治疗糖尿病肾病的随机对照试验(RCT)文献。根据Revman软件上提供的偏倚风险评估工具评价文献质量,采用Rev Man 5.3.1软件进行Meta分析。结果共纳入15个RCT,Meta分析结果显示,相较于贝那普利单药治疗,贝那普利联合厄贝沙坦治疗糖尿病肾病更能显著地降低尿白蛋白排泄率[MD=-1.49,95%CI(-2.89^-0.09),P=0.04],降低血肌酐[MD=-5.02,95%CI(-9.75^-0.29),P=0.04],降低收缩压[MD=-6.12,95%CI(-9.58^-2.67),P=0.0005]和舒张压[MD=-3.24,95%CI(-4.82^-1.67),P<0.0001],提高总有效率[RR=1.30,95%CI(1.15~1.47),P<0.0001],而血尿素氮、24 h尿蛋白、内生肌酐清除率、血钾、空腹血糖、糖化血红蛋白以及不良反应2组间差异无统计学意义。结论目前证据显示贝那普利联合厄贝沙坦优于单用贝那普利治疗糖尿病肾病,但鉴于该Meta分析纳入文献数量有限且质量中等,结论尚需规范的大规模、多中心RCT论证。

Objective This study aimed to observe the clinical effects of benazepril combined with irbesartan in the treatment of diabetic nephropathy.Methods Randomized controlled trials （RCTs）on the treatment of benazepril combined with irbesartan by clinical effectiveness and safety on the patients with for diabetic nephropathy （DN） were searched electronically in medical debases. The Bias risk assessment tool provided by Revman software was employed to evaluate methodological quality. Rev Man5.3.1 software was used for the meta-analysis. Results 15RCT were enrolled in this meta-analysis. The results showed that benazepril combined with irbesartan was more effectively in decreasing urinary albumin excretion rate [MD=-1.49,95%CI（-2.89--0.09）,P=0.04], reducing the serum creatinine [MD=-5.02,95% CI（-9.75--0.29）, P=-0.04], decreasing the systolic blood pressure [MD=-6.12,95% CI （-9.58--2.67）, P=-0.0005] and diastolic blood pressure [MD=-3.24,95%CI （--4.82--1.67）,P〈0.0001]as well as increasing the total effective rate [RR=1.30,95%CI （1.15-1.47）,P〈0.0001]. However,there were no statistical differences in the blood urea nitrogen values,24 -hour urinary protein,endogenous creatinine clearance rate, serum potassium,fasting blood-glucose, glycosylated hemoglobin between the two groups.Conclusions Currently published evidence from RCTs suggests that benazepril combined with irbesartan in the treatment of diabetic nephropathy is superior to conventional therapy alone, however, available studies are not adequate to draw a conclusion on the superiority and safety of benazepril combined with irbesartan treatment due to the methodological flaws of the included trials, we hope that our work could provide useful experience on further studies and more well-designed trials are needed to confirm our findings.