贝尼地平对高血压患者的肾脏保护效果的Meta分析

Renal protection effects of benidipine in patients with hypertension:meta-analysis

目的系统评价三亚型钙通道阻滞剂(CCB)贝尼地平对高血压患者肾脏保护效益,以为临床应用提供循证证据支持。方法计算机系统性检索Pub Med、Ovid-Embase、Cochrane图书馆、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CJFD)、万方数据库和中国科技期刊全文数据库(CSJD)等电子数据库,纳入贝尼地平对高血压患者肾脏保护效益的随机对照试验、半随机对照试验或临床对照试验。采用Cochrane Handbook 5.0.1推荐的工具对纳入研究的偏倚风险进行评估,并采用Stata 12.0软件进行Meta分析。结果最终纳入10项随机对照临床试验,包括931例患者。贝尼地平在降低尿蛋白、尿蛋白/肌酐比值和血浆醛固酮水平方面优于其他CCB类药物[尿蛋白:SMD=2.00,95%CI:1.23~2.77,P<0.001;尿蛋白/肌酐比值:MD=457.00,95%CI:251.15~662.85,P<0.001;血浆醛固酮水平:MD=20.80,95%CI:18.53~23.07,P<0.001];在改善肌酐清除率、肾小球滤过率、收缩压和舒张压的降低等方面,与其他降压药物无显著差异。结论贝尼地平在降低尿蛋白、尿蛋白/肌酐比值和血浆醛固酮水平方面优于其他CCB,与肾素-血管紧张素-醛固酮系统抑制剂(RAASi)类药物无显著差异,具有较好的肾脏保护作用。

Objective The meta-analysis was conducted to systematically review the efficacy of benidipine(anL-,N-and T-type calcium channel blocker,CCB)in the treatment of hypertension combined with chronic kidneydisease and to provide references for clinical selection.Methods PubMed,Ovid-EMbase,the Cochrane Library,CBM,CJFD,CNKI,WanFang Data and CSJD were systemically searched up to collect randomized controlledtrials(RCTs),Quasi-RCTs,or clinical controlled trials(CCTs)on benidipine in the treatment of hypertensioncombined with chronic kidney disease.The risk of bias was evaluated by Cochrane collaboration’s tool.Thenmeta-analysis was performed using Stata12.0.Results Ten RCTs were finally included involving931patients.The results of meta-analysis indicated that benidipine was better than other CCBs in decreasing proteinuria,urinaryprotein to creatinine ratio and plasma aldosterone concentration[Proteinuria:SMD=2.00,95%CI:1.23~2.77,P=0.000;Urinary Protein to Creatinine Ratio:MD=457.00,95%CI:251.15~662.85,P=0.000;Plasma AldosteroneConcentration:MD=20.80,95%CI:18.53~23.07,P=0.000].However,there was no significant difference betweentwo groups in improving the creatinine clearance,GFR,decreasing systolic and diastolic blood pressure,etc.Conclusion In respects of decreasing proteinuria,urinary protein/creatinine ratio and plasma aldosterone level,benidipine was significantly better than other CCBs and comparable to RAASi-type drugs,which demonstrated apositive role of benidipine in kidney protection.