他汀类药物治疗早期糖尿病肾病的Meta分析  

Statins for Early Diabetic Kidney Disease:A Systematic Review

作　　者：崔文鹏[1] 杜冰[2] 贾冶[1] 许钟镐[1] 苗里宁[1] 

机构地区：[1]吉林大学第二医院肾病内科,长春130041 [2]吉林大学第一医院二部心血管内科,长春130031

出　　处：《中国循证医学杂志》2010年第1期81-88,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价他汀类药物治疗早期糖尿病肾病(DKD)的疗效。方法计算机检索Cochrane图书馆临床对照试验资料库(2009年第2期)、MEDLINE(1991～2009年8月)、EMbase(1991～2009年8月)、CBMdisc(1991～2009年8月)、CNKI(1994～2009年8月),手工检索相关文献,按纳入与排除标准选择随机对照试验(RCT)。评价质量及提取资料后,采用RevMan4.2软件对数据进行Meta分析。结果初检出281篇文献,经筛选最终纳入22篇文献共25个RCT,包括1838例患者。纳入文献总体质量不高,均为C级。由于各研究间存在异质性,故采用随机效应模型进行效应量合并。Meta分析结果显示,试验组尿白蛋白排泄率(UAER)[WMD=-55.77,95%CI(-74.20,-37.34),P<0.00001]、血肌酐(Scr)[WMD=-4.34,95%CI(-6.74,-1.94),P=0.0004]、C反应蛋白(CRP)[WMD=-1.48,95%CI(-2.32,-0.63),P=0.006]、总胆固醇(TC)[WMD=-1.33,95%CI(-1.75,-0.91),P<0.00001]以及甘油三脂(TG)[WMD=-0.72,95%CI(-1.17,-0.27),P=0.002]较对照组均明显降低。倒漏斗图散点分布近似左右对称,提示纳入研究存在发表偏倚可能性小。纳入的22篇文献共报道12例患者出现转氨酶升高,经保肝治疗恢复正常,未见严重不良反应事件的报道。结论现有研究结果表明,他汀类药物在调节早期DKD患者血脂的同时,可以降低UAER和Scr,具有肾脏保护作用,其机制可能与降低血CRP水平有关,不良反应轻微。由于本研究纳入文献的质量缺陷,尚需更多高质量的随机双盲对照试验证实结论。Objective To assess the effectiveness of statins in treating early diabetic kidney disease （DKD）. Methods We searched the Cochrane Central Register of Controlled Trials （Issue 2, 2009）, MEDLINE （1991 to August 2009）, EMbase （1991 to August 2009）, CBMdisc （1991 to August 2009） and CNKI （1994 to August 2009）. We also handsearched relevant journals and conference proceedings. Randomized controlled trials （RCTs） in which statins were used to treat patients with early DKD were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by RevMan 4.2 software. Re- sults A total of 281 articles were found and 22 articles inolving 1838 patients were finally included. All these articles were regarded as low quality. We chose the random-effect model to conduct meta-analysis because significant heterogeneities were found among these articles. The results of meta-analysis showed that after treatment with statins, there were signifi- cant reductions in urinary albumin excretion rate （UAER） （WMD= -55.77, 95%CI -74.20 to -37.34, P〈0.000 01）, serum creatinine （Scr） （WMD= -4.34, 95%CI -6.74 to -1.94, P=0.000 4）, C reactive protein （CRP） （WMD= -1.48, 95%CI - 2.32 to -0.63, P--0.006）, total cholesterol （TC） （WMD= -1.33, 95%CI -1.75 to -0.91, P〈0.000 01）, and triglyceride （TG） （WMD= -0.72, 95%CI-1.17 to -0.27, P=0.002） in group treatment compared with group control. Funnel-plot displayed a symmetrical figure, indicating there was no publication bias. No severe adverse effects were found in these articles except 12 patients with high level oftransaminase which were cured after using hepatic protect therapy. Conclusion Currently available evidence shows that with the reduction of TC and TG, statins may decrease UAER and Scr in patients with early DKD and the reduction of CRP may be involved in the mechanism. Statins provide effective renal pro

关 键 词：他汀类药物 早期糖尿病肾病 系统评价 随机对照试验 

分 类 号：R587.2[医药卫生—内分泌] R195.1[医药卫生—内科学]