复方丹参滴丸联合血管紧张素Ⅱ受体拮抗药对比单用血管紧张素Ⅱ受体拮抗药治疗糖尿病肾病疗效的Meta分析

Therapeutic Efficacy of Compound Danshen Dripping Pill Combined with Angiotensin Ⅱ Receptor Blocker versus Angiotensin Ⅱ Receptor Blocker Alone for Diabetic Nephropathy:A Meta-analysis

目的:系统评价复方丹参滴丸联合血管紧张素Ⅱ受体拮抗药对比单用血管紧张素Ⅱ受体拮抗药治疗糖尿病肾病的疗效,为临床治疗提供参考。方法:计算机检索自建库起至2018年6月2日PubMed、Cochrane图书馆、Embase、中国期刊全文数据库、中文科技期刊数据库、万方数据库和中国生物医学文献数据库中收录的复方丹参滴丸联合血管紧张素Ⅱ受体拮抗药(试验组)对比单用血管紧张素Ⅱ受体拮抗药(对照组)治疗糖尿病肾病的随机对照试验(RCT),对符合纳入标准的文献进行资料提取,并采用Cochrane系统评价员手册5.0.1进行质量评价后,采用Stata 14.0软件对血肌酐水平降低程度、尿蛋白排泄水平降低程度、血脂(血清总胆固醇、三酰甘油、低密度脂蛋白)水平降低程度、餐后2 h血糖水平降低程度、尿微量白蛋白水平降低程度进行Meta分析。结果:共纳入12项RCT,合计882例患者。Meta分析结果显示,试验组尿蛋白排泄率水平[WMD=-18.54,95%CI(-23.67,-13.40),P<0.001]、血肌酐水平[WMD=-5.28,95%CI(-10.22,-0.35),P<0.001]、总胆固醇水平[WMD=-1.70,95%CI(-2.53,-0.87),P<0.001]、三酰甘油水平[WMD=-0.88,95%CI(-1.26,-0.49)]、低密度脂蛋白水平[WMD=-0.57,95%CI(-1.09,-0.05),P<0.001]、餐后2 h血糖水平[WMD=-0.43,95%CI(-0.92,-0.05),P<0.001]、尿微量白蛋白水平[WMD=-13.73,95%CI(-20.73,-6.73),P<0.001]降低程度均优于对照组。结论:复方丹参滴丸联合血管紧张素Ⅱ受体拮抗药对比单用血管紧张素Ⅱ受体拮抗药能够显著改善糖尿病肾病患者血肌酐、尿蛋白排泄、总胆固醇、三酰甘油、低密度脂蛋白、餐后2 h血糖、尿微量白蛋白水平。

OBJECTIVE：To systematically review therapeutic efficacy of Compound danshen dripping pill combined with angiotensin Ⅱ receptor blocker versus angiotensin Ⅱ receptor blocker alone for diabetic nephropathy,and to provide reference for clinical use. METHODS：Retrieved from PubMed,Cochrane library,Embase,CNKI,VIP,Wanfang database and CBM from database establishment to June 2,2018,RCTs about Compound danshen dripping pills combined with angiotensin Ⅱ receptor blocker（trial group）versus angiotensin Ⅱ receptor blocker alone（control group）for diabetic nephropathy were collected. After data extraction of included literatures,quality evaluation was performed by using Cochrane system evaluator manual 5.0.1.Meta-analysis was performed for the decrease degree of serum creatinine,urinary protein excretion rate level,blood lipid（TC,TG,LDL-C）,2 h postprandial blood glucose and microalbuminuria by using Stata 14.0 software. RESULTS：There were 12 RCTs,including 882 patients. Results of Meta-analysis showed that the decrease degree of urinary protein excretion rate level [WMD=-18.54,95%CI（-23.67,-13.40）,P〈0.001],serum creatinine [WMD=-5.28,95%CI（-10.22,-0.35）,P〈0.001], TC [WMD=- 1.70,95% CI（- 2.53,- 0.87）,P〈0.001],TG [WMD=- 0.88,95% CI（- 1.26,- 0.49）,P〈0.001],LDL-C [WMD=-0.57,95%CI（-1.09,-0.05）,P〈0.001],2 h postprandial blood glucose [WMD=-0.43,95%CI（-0.92,-0.05）,P〈0.001],microalbuminuria [WMD=-13.73,95%CI（-20.73,-6.73）,P〈0.001] in trial group were better than that in control group. CONCLUSIONS：Compared with angiotensin Ⅱ receptor blocker alone,Compound danshen dripping pill combined with angiotensin Ⅱ receptor blocker can significantly improve serum creatinine,urinary protein excretion rates,TC,TG,LDL-C,2 hpostprandial blood glucose and microalbuminuria in patient with diabetic nephropathy.