雷公藤多苷联合血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂治疗糖尿病肾病的荟萃分析

Tripterygium Glycosides in Combination with Angiotensin Converting Enzyme Inhibitors/AngiotensinⅡReceptor Blockers for Diabetic Nephropathy:A Meta-analysis

目的系统评价雷公藤多苷联合血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体阻滞剂治疗糖尿病肾病的有效性和安全性。方法检索相关随机对照试验,根据纳入排除标准进行文献筛选,并对其进行方法学质量评价及荟萃分析。结果共纳入24篇文献,2171例糖尿病肾病患者。与对照组相比,试验组可明显提高临床疗效〔OR=3.13,95%CI(2.26,4.33),P<0.00001〕,降低24 h尿蛋白〔MD=-0.69,95%CI(-0.83,-0.56),P<0.00001〕、血肌酐〔MD=-7.90,95%CI(-15.34,-0.45),P=0.04〕、血尿素氮〔MD=-0.34,95%CI(-0.65,-0.04),P=0.03〕,升高血清白蛋白〔MD=3.44,95%CI(2.29,4.59),P<0.00001〕,改善患者空腹血糖〔MD=-0.19,95%CI(-0.29,-0.08),P=0.0008〕,但糖化血红蛋白两组间无统计学差异(P=0.05)。不良反应发生率方面,试验组高于对照组〔RD=0.03,95%CI(0.00,0.06),P=0.04〕。结论雷公藤多苷联合血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂治疗糖尿病肾病,在临床疗效、肾功能及空腹血糖方面优于单独应用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂。

Objective To evaluate the efficacy and safety of tripterygium glycosides combined with angiotensin converting enzyme inhibitors or angiotensinⅡreceptor blockers in the treatment of diabetic nephropathy.Methods Related randomized controlled trials were retrieved.Studies were screened according to the inclusion and exclusion criteria,and evaluated methodologically and via meta-analysis.Results A total of 24 studies involving 2171 patients with diabetic nephropathy were included.Compared with the control group,clinical efficacy was improved significantly〔OR=3.13,95%CI(2.26,4.33),P<0.00001〕,24 h urine protein〔MD=-0.69,95%CI(-0.83,-0.56),P<0.00001〕,blood creatinine〔MD=-7.90,95%CI(-15.34,-0.45),P=0.04〕,and blood urea nitrogen were reduced〔MD=-0.34,95%CI(-0.65,-0.04),P=0.03〕,serum albumin was elevated〔MD=3.44,95%CI(2.29,4.59),P<0.00001〕,and fasting glucose in patients was lowered〔MD=-0.19,95%CI(-0.29,-0.08),P=0.0008〕in the experimental group,but there was no statistically significant difference in levels of glycated hemoglobin between the two groups(P=0.05).The incidence of adverse reactions was higher in the experimental group than in the control group〔RD=0.03,95%CI(0.00,0.06),P=0.04〕.Conclusion The combination of tripterygium glycosides and angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blockers for diabetic nephropathy is superior to angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blockers used alone in terms of clinical efficacy,renal function and fasting glucose.