西尼地平对高血压患者蛋白尿水平及血压影响的Meta分析

Effects of Cilnidipine on blood pressure and proteinuria level in hypertensive patients:a Meta-analysis

目的系统比较L/N型钙通道阻滞剂西尼地平与L型钙通道阻滞剂(L-CCB)对高血压患者蛋白尿水平和血压的影响。方法检索PubMed、Embase、Cochrane Library、中国知网及万方数据库,收集从建库至2019年12月24日发表的以西尼地平为治疗措施,L-CCB为对照措施,高血压患者为研究对象的随机对照试验,依据Cochrane风险偏倚评估工具进行质量评价,采用RvMan 5.3进行Meta分析,Stata 12进行偏倚分析和敏感性分析。结果共纳入13篇文献,14项研究。Meta分析显示:西尼地平在血压控制方面与L-CCB不存在差异,在减少蛋白尿(尿白蛋白/肌酐>30 mg/g)方面明显优于L-CCB(SMD=-0.31,95%CI:-0.41~-0.20,P<0.0001),基线蛋白尿水平是主要的异质性来源。当按蛋白尿产生原因分析时,西尼地平对糖尿病引起的大量蛋白尿(尿白蛋白/肌酐>300 mg/g)的降低作用优于L-CCB(SMD=-0.74,95%CI:-1.38~-0.11,P=0.02),在微量蛋白尿(尿白蛋白/肌酐:30~300 mg/g)降低方面无明显差异(SMD=-0.12,95%CI:-0.38~0.14,P=0.37)。结论西尼地平在保持降压作用的同时,在降蛋白尿方面较L-CCB有优势,但其更倾向于降低高血压或慢性肾脏病引起的蛋白尿,而对糖尿病引起蛋白尿的降低作用还需要进一步研究。

Objective This study was designed to systematically evaluate the effects of L/N type calcium channel blocker Cilnidipine and L type calcium channel blocker on proteinuria and blood pressure in hypertensive patients.Methods PubMed,Embase,Cochrane Library,CNKI and WanFang database were searched from the date of databases'establishment to December 24,2019,included the randomized controlled trials base on the criteria of using Cilnidipine as the treatment drug and L-type calcium channel blockers(L-CCB)as the control drug in hypertensive patients.The qualities of the literatures were evaluated following Cochrane risk of bias assessment tools.RevMan 5.3 was used for Meta-analysis.Stata 12 was used for bias analysis and sensitivity analysis.Results A total of 13 literatures and 14 studies were included.Meta-analysis showed that there was no difference between Cilnidipine and L-CCB in blood pressure control,and it was significantly better than L-CCB in reducing proteinuria(urinary albumin/creatinine>30 mg/g)(SMD=-0.31,95%CI:-0.41~-0.20,P<0.0001).Baseline proteinuria levels were the main source of heterogeneity.When analyzed according to the source of proteinuria,the effect of Cilnidipine on the reduction of macroproteinuria(urinary albumin/creatinine>300 mg/g)caused by diabetes was better than LCCB(SMD=-0.74,95%CI:-1.38~-0.11,P=0.02),and there was no significant difference in the reduction of microproteinuria(urinary albumin/creatinine:30~300 mg/g)(SMD=-0.12,95%CI:-0.38~0.14,P=0.37).Conclusion While maintaining the anti-hypertension effect,Cilnidipine has an advantage over L-CCB in lowering proteinuria,but it tends to reduce proteinuria caused by hypertension or primary renal disease,and its protective effect on proteinuria caused by diabetes still needs further study.