阿魏酸钠治疗糖尿病肾损害的系统评价  

Sodium Ferulate for Diabetic Kidney Disease:A Systematic Review

作　　者：王锋[1,2] 汪国贵[1] 葛卫红[1] 李晓萍[1] 邬云红[1] 袁启远[3] 李婷[2] 吴红梅[2] 孙红娟[4] 

机构地区：[1]四川大学华西医院西藏成办分院,成都610041 [2]四川大学华西医院老年科,成都610041 [3]四川省第五人民医院,成都610031 [4]西藏自治区第一人民医院,拉萨850000

出　　处：《中国循证医学杂志》2009年第6期652-669,共18页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价阿魏酸钠治疗糖尿病肾损害(DKD)的疗效与安全性。方法计算机检索Cochrane图书馆临床对照试验资料库(2008年第4期)、MEDLINE(1996～2008.12)、EMbase(1980～2008.12)、CBMdisc(1990～2008.12)、CNKI(1994～2008.12)和VIP(1989～2008.12),手工检索相关文献,纳入阿魏酸钠治疗糖尿病肾损害的随机对照试验(RCT)。根据Cochrane评价员手册5.0版评估纳入研究的偏倚风险,采用RevMan5.0软件进行统计分析。结果纳入39个RCT,共2351例2型糖尿病损害患者。大部分研究方法学质量较低且样本含量较小,存在发生偏倚的高度风险,Meta分析显示:①肾功能指标:尿白蛋白排泄率[WMD=-42.92,95%CI(-52.61,-33.23)]、24h尿蛋白定量[WMD=-0.11,95%CI(-0.16,-0.05)]、尿素氮[WMD=-0.76,95%CI(-1.04,-0.46)]、血清肌酐[WMD=-8.38,95%CI(-11.81,-4.94)],阿魏酸钠组均优于常规治疗组;②血糖指标:空腹血糖[WMD=-0.27,95%CI(-0.48,-0.06)];餐后2h血糖[早期:WMD=-0.22,95%CI(-0.49,0.04);临床期:WMD=-2.39,95%CI(-3.23,-1.54)];糖化血红蛋白[WMD=-0.12,95%CI(-0.27,0.02)];阿魏酸钠组在改善空腹血糖和临床期餐后2h血糖方面优于常规治疗组,但在改善糖化血红蛋白和早期餐后2h血糖方面与常规治疗组相当;③血压指标:收缩压[早期:WMD=-1.80,95%CI(-2.80,-0.81);临床期WMD=-8.95,95%CI(-16.93,-0.96)]、舒张压[早期:WMD=-1.25,95%CI(-4.37,1.87);临床期:WMD=-0.99,95%CI(-2.48,0.50)]、平均动脉压[WMD=-0.74,95%CI(-1.08,-0.40)],阿魏酸钠组在改善收缩压和平均动脉压方面优于常规治疗组,但在改善舒张压方面与常规治疗组相当;④血脂指标:总胆固醇[WMD=-0.70,95%CI(-1.01,-0.39)]、甘油三酯[早期:WMD=-0.12,95%CI(-0.28,0.04);临床期:WMD=-0.96,95%CI(-1.49,-0.43)]、高密度脂蛋白胆固醇[WMD=0.14,95%CI(0.06,0.22)],阿魏酸钠组对改善总胆固醇、高密度脂蛋白胆固醇及临床期甘油三酯方面优于常规治疗组,但在改善早期甘油三酯方面与常规治疗组相当;⑤内皮�Objective To assess the efficacy and safety of Sodium ferulate for diabetic kidney disease. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the Cochrane Central Register of Controlled Trials （Issue 4, 2008）, MEDLINE （1996 to December 2008）, EMbase （1980 to December 2008）, CBMdisc （1990 to December 2008）, CNKI （1994 to December 2008） and VIP （1989 to December 2008）. And we also hand searched relevant journals and conference proceedings. We evaluated the risk of the bias of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration＇s software RevMan 5.0 was used for meta-analysis. Results Thirty-nine RCTs were enrolled in the review, including 2 351 patients with type 2 diabetic kidney disease met the inclusion criteria. Most of these trials were small and of low quality with a high risk of bias. The results of meta-analysis showed that ① Sodium ferulate was better on attenuating UAER （WMD=-42.92, 95%CI -52.61 to -33.23）, 24 hours urinary protein （WMD=-0.11, 95%CI -0.16 to -0.05）, BUN （WMD=-0.76, 95%CI -1.04 to -0.46） and Scr （WMD=-8.38, 95%CI -11.81 to -4.94）; Sodium ferulate was better on the regulation of FBG and 2 h-BG of clinical DKD （WMD= -2.39, 95%CI -3.23 to -1.54）, but not superior to routine treatment on the improvement of HbAlc （WMD=-0.12, 95%CI -0.27 to 0.02） and 2 h-BG of early DKD （WMD=-0.22, 95%CI -0.49 to 0.04）; Sodium ferulate was better on the improvement of SBP and MAP, however, Sodium ferulate was not superior to routine treatment on the improvement of DBP; Sodium ferulate was better on the improvement of TC （WMD=-0.70, 95%CI -1.01 to -0.39）, HDL-c （WMD= 0.14, 95%CI 0.06 to 0.22） and TG of clinical DKD （WMD=-0.96, 95%CI -1.49 to -0.43）, but not superior to routine treatment on the improvement of TG of early DKD （WMD=-0.12, 95%CI -0.28 to 0.04）; Sodium ferulate was better on the improvement of serum endothelin �

关 键 词：阿魏酸钠 糖尿病肾损害 随机对照试验 系统评价 META分析 

分 类 号：R587.2[医药卫生—内分泌] R285.5[医药卫生—内科学]