己酮可可碱联合ACEI/ARB类药物治疗糖尿病肾脏病的临床疗效和安全性Meta分析

Meta-analysis of the clinical efficacy and safety of pentoxifylline combined with ACEI/ARB drugs in the treatment of diabetic kidney disease

目的系统评价己酮可可碱联合血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)类药物治疗糖尿病肾脏病的临床疗效及安全性,为己酮可可碱治疗糖尿病肾脏病提供新的循证依据。方法检索中国期刊全文数据库、万方数据库、EMBASE、PubMed、Cochrane Library等中外文数据库。检索起止时间为建库起至2021年2月20日,所有纳入的文献都属于随机对照试验。比较治疗组(己酮可可碱+常规治疗联合ACEI/ARB)和对照组(常规治疗联合ACEI/ARB)对患者的尿蛋白、肾功能、糖代谢、血压和不良反应的差异。采用Rev Man 5.3进行Meta分析。结果总共纳入18项随机对照试验,共1401例2型糖尿病肾脏病患者,治疗组724例,对照组677例。Meta分析结果显示:与对照组相比,治疗组能明显降低患者24 h尿蛋白(WMD=-0.53,95%CI:-0.58~-0.49,P<0.001)、收缩压(WMD=-1.97,95%CI:-3.51~-0.44,P=0.01)、空腹血糖(WMD=-0.32,95%CI:-0.58~-0.06,P=0.01)、糖化血红蛋白(WMD=-0.2,95%CI:-0.32~-0.08,P<0.01),两组均未发现严重不良反应。结论己酮可可碱联合ACEI/ARB类药物在改善糖尿病肾脏病患者蛋白尿、收缩压、糖代谢方面优于单独应用ACEI/ARB类药物,具有较好的临床疗效。仍需要高质量、多中心、大样本的临床随机对照试验进行证实。

Objective To systematically evaluate the clinical efficacy and safety of pentoxifylline(PTX)combined with ACEI/ARB drugs in the treatment of diabetic kidney disease,and provide new evidence-based data for pentoxifylline in the treatment of diabetic kidney disease.Methods Chinese and foreign language databases were retrieved including CNKI,Wanfang,EMBASE,PubMed,and Cochrane Library,etc.The retrieval was from the establishment of the database to February 20,2021.All the included documents were randomized controlled trials.The differences in urine protein,renal function,glucose metabolism,blood pressure and adverse reactions between the treatment group(pentoxifylline and conventional treatment combined with ACEI/ARB)and the control group(conventional treatment combined with ACEI/ARB)were compared.Rev Man 5.3 software was used for meta-analysis.Results A total of 18 randomized controlled trials were included,with a total of 1401 patients with type 2 diabetic nephropathy,including 724 cases in the treatment group and 677 cases in the control group.Meta-analysis results showed that compared with the control group,the treatment group significantly reduced the 24-hour urine protein(WMD=-0.53,95%CI:-0.58 to-0.49,P<0.001),systolic blood pressure(WMD=-1.97,95%CI:-3.51 to-0.44,P=0.01),fasting blood glucose(WMD=-0.32,95%CI:-0.58 to-0.06,P=0.01),and glycated hemoglobin(WMD=-0.2,95%CI:-0.32 to-0.08,P<0.01),while no severe adverse reactions were found in both two groups.Conclusion Pentoxifylline combined with ACEI/ARB drugs was superior to ACEI/ARB drugs alone in improving the proteinuria,systolic pressure,and sugar metabolism of patients with diabetic kidney disease,showing better clinical efficacy.Clinical randomized controlled trials of high-quality,multi-center,and large-sample are still needed for further confirmation.