摘要
目的系统评价糖尿病肾病(diabetic kidney disease,DKD)患者在血管紧张素受体拮抗剂(angiotensin receptorblockers,ARBs)治疗基础上联用吡格列酮的临床疗效。方法检索CNKI、万方、EMBASE、PubMed、Cochrane Library等中外文数据库,纳入文献为随机对照实验。应用RevMan5.3对实验组(吡格列酮+ARBSs组)和对照组(ARBs常规治疗组)治疗DKD的临床疗效、尿蛋白、肾功能、糖代谢以及脂代谢情况进行Meta分析。结果纳入7项随机对照实验,共592例患者,其中实验组298例,对照组294例。结果显示,对照组有效率显著低于实验组,且异质性较好。与对照组比较,实验组加用吡格列酮可显著降低DKD患者24h尿蛋白水平和尿蛋白排泄率,同时能改善肾功能,减少空腹血糖、餐后2h血糖、糖化血红蛋白和胆固醇水平(P均<0.05)。纳入文献报道均未发现严重不良反应。另外,尿素氮、甘油三酯和低密度脂蛋白结局指标比较,差异无统计学意义(P>0.05)。结论吡格列酮联合ARBs药物在改善DKD患者尿蛋白、肾功能、糖代谢和脂代谢等方面均优于单独应用常规ARBs药物,具有较好的临床疗效。
Objective To systematically evaluate the clinical efficacy of pioglitazone combined with an angiotensin receptor blockers(ARBs)in treating diabetic kidney disease.Methods Chinese and English databases including Wanfang,EMBASE,PubMed,Cochrane Library,etc were searched for randomized controlled trials about the clinical efficacy of pioglitazone plus ARBs vs ARBs alone in patients of diabetic kidney disease.The indices of clinical efficacy included the urinary protein,renal function,glucose metabolism and lipid profiles etc.RevMan5.3 was used for data analysis.Results Seven randomized controlled trials were included.A total 592 DKD patients were analyzed.It showed that ARBs alone in the control group(n=294)was significantly less efficient than pioglitazone plus ARBs therapy in the experimental group(n=298).Pioglitazone plus ARBs therapy could significantly reduce urinary protein levels and urinary protein excretion rate,improve renal function,fasting blood glucose,2 hours postprandial blood glucose,hemoglobin and cholesterol levels than ARBs alone in diabetic kidney disease(P<0.05).No serious adverse reactions were found in the included literature reports.In addition,there was no significant difference in triglycerides,BUN and LDL(P>0.05).Conclusion Pioglitazone combined with ARBs drugs has better clinical efficacy over conventional ARBs drugs alone in improving urinary protein,renal function,glucose metabolism and lipid metabolism in DKD patients.
作者
曹玲艳
樊文星
陈广梅
周勇丽
何佳敏
CAO Lingyan;FAN Wenxing;CHEN Guangmei(The First Affiliated Hospital of Kunming Medical University,Yunnan 650032,China)
出处
《医学研究杂志》
2022年第12期38-43,185,共7页
Journal of Medical Research
基金
国家自然科学基金资助项目(82160142)
云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(杰出青年培育项目)(202201AY070001-044)
云南省卫生健康委员会医学学科带头人培养项目(D-2018027)。
