左旋氨氯地平对原发性高血压患者肾功能保护作用的Meta分析  

Protective Effect of Levamlodipine on Renal Function in Patients with Essential Hypertension:A Meta-analysis

作　　者：于欢[1,2] 陈忻[1,2] 翟所迪[1] 

机构地区：[1]北京大学第三医院药剂科,北京市100191 [2]北京大学医学部药学院药事管理与临床药学系,北京市100191

出　　处：《中国药房》2011年第36期3433-3437,共5页China Pharmacy

摘　　要：目的:系统评价左旋氨氯地平对原发性高血压患者肾功能的保护作用。方法:计算机检索Cochrane图书馆临床对照试验资料库、PubMed、EMBase、万方电子期刊、中国知网(CNKI)、中国科技期刊数据库(VIP)、中国生物医学文献数据库(CBM),对纳入的文献进行质量评价与数据提取后,用RevMan5.1软件对数据进行分析。结果:共纳入18篇34项RCT,包括1421例患者;根据Cochrane的文献质量评价标准,所有文献均为C级。Meta分析结果显示,左旋氨氯地平与血管紧张素转化酶抑制剂(ACEI)和血管紧张素Ⅱ受体拮抗药(ARB)在降低24h尿微量白蛋白[WMD=1.50,95%C(I-3.90,6.91),P=0.59]、尿β2微球蛋白(β2-MG)的[WMD=0.00,95%C(I-0.01,0.00),P=0.79]、24h尿蛋白[WMD=0.00,95%C(I-0.01,0.02),P=0.58]、24h尿白蛋白[WMD=-0.23,95%C(I-11.18,10.73),P=0.97]作用上无显著性差异;左旋氨氯地平与ACEI/ARB联合使用时对尿β2-MG[WMD=-0.02,95%C(I-0.03,-0.01),P=0.0001]、24h尿蛋白[WMD=-0.04,95%C(I-0.06,-0.03),P<0.00001]、24h尿白蛋白[WMD=-10.52,95%C(I-16.74,-4.31),P=0.0009]的降低作用强于ACEI/ARB单药治疗,而对24h尿微量白蛋白的降低作用的强度与ACEI/ARB相同[WMD=-8.11,95%C(I-17.95,1.73),P=0.11]。结论:左旋氨氯地平的肾功能保护作用的强度与ACEI或ARB相同;左旋氨氯地平与ACEI/ARB联合使用能够更有效地保护肾功能。由于本研究存在一定局限性,需要更多高质量、大样本的随机双盲对照试验来对左旋氨氯地平的肾脏保护作用进行研究。OBJECTIVE：To evaluate the protective effect of levamlodipine on renal function in patients with essential hypertension systematically.METHODS：Retrieved from Clinical Controlled Trials Database of Cochrane Library,PubMed,EMBase,Wanfang Database,CNKI,VIP and CBM,randomized controlled trials（RCTs） were screened according to predefined inclusion and exclusion criteria.Then we evaluated the quality of the included studies,and performed meta-analyses by Rev Man 5.1 software.RESULTS：A total of 18 articles involving 34 RCTs and 1 421 patients were included.All these articles were regarded as low quality according to Cochrane quality evaluation criteria.The result of meta-analysis showed that there were no significant reductions between levamlodipine and ACEI/ARB in 24 h microalbuminuria [WMD=1.50,95%CI（-3.90,6.91）,P=0.59],urine β2-MG [WMD=0.00,95%CI（-0.01,0.00）,P=0.79],24 h urine protein [WMD=0.00,95%CI（-0.01,0.02）,P=0.58] and 24 h urinary albumin [WMD=-0.23,95%CI（-11.18,10.73）,P=0.97].Combination treatment of levamlodipine and ACEI/ARB was more effective on reducing urine β2-MG [WMD=-0.02,95%CI（-0.03,-0.01）,P=0.000 1],24 h urine protein [WMD=-0.04,95%CI（-0.06,-0.03）,P0.000 01],24 h urinary albumin [WMD=-10.52,95%CI（-16.74,-4.31）,P=0.000 9],compared with ACEI/ARB alone therapy.However,there was no significant difference between combination treatment and ACEI/ARB in reducing 24 h microalbuminuria [WMD=-8.11,95%CI（-17.95,1.73）,P=0.11].CONCLUSION：Currently available evidence shows that the renal protective effect of levamodipine is the same as ACEI/ARB,and the combination of levamodipine and ACEI/ARB is more effective than ACEI/ARB on renal function protection.However,due to the lack of quality in the included studies,more high-quality larger-scale randomized double-blind controlled trials should be conducted.

关 键 词：左旋氨氯地平 原发性高血压 肾功能 保护作用 META分析 

分 类 号：R544[医药卫生—心血管疾病]