T-型CCB与ACEI/ARB治疗高血压合并慢性肾病疗效的系统评价  

A System Review: The Effects of T-type CCB or ACEI /ARB for Hypertensive Patients with Chronic Kidney Disease

作　　者：张媛[1] 吴禹蒙[2] 吴玉波[2] 

机构地区：[1]金华职业技术学院,浙江金华321016 [2]哈尔滨医科大学附属第四医院药学部,哈尔滨150001

出　　处：《中国药学杂志》2013年第22期1965-1969,共5页Chinese Pharmaceutical Journal

摘　　要：目的系统评价T-型CCB治疗高血压合并慢性肾病患者的疗效是否等同或优于ACEI/ARB对这部分患者的疗效。方法计算机检索Cochrane Library,Pubmed,EMbase,CNKI等数据库,检索时间截止至2012年5月。收集符合纳入标准的临床随机对照试验,采用Revman 5.1对纳入的研究进行meta分析。结果最终纳入5个临床随机对照研究,563名高血压合并慢性肾病的受试者。Meta分析结果表明,T-型CCB在提高受试者肌酐清除率和肾小球滤过率方面与ACEI/ARB效果相当,但降低蛋白尿的效果不如ACEI/ARB(3个RCTs,389名受试者,WMD 0.26 g·d-1,95%CI 0.10 to 0.43)。血压的分析结果显示,无论T-型CCB还是ACEI/ARB都具有较强的降压效果。结论 T-型CCB能有效地控制血压和改善肾脏指标,对高血压合并慢性肾病患者有一定疗效。但其降低蛋白尿的效果不如ACEI/ARB,不建议用于蛋白尿是主要症状的高血压合并慢性肾病患者。OBJECTIVE To evaluate whether T-type CCBs are equivalent with or superior to ACEIs/ARBs on renal outcomes in hupertensive patients with chronic kidney disease. METHODS Cochrane Library, Pubmed, EMbase and CNKI were searched for relevant randomized controlled trials （RCTs） from inception to May 2012. The meta-analysis was performed by Revman 5.1 software. RESULTS Five RCTs （563 subjects） were included in the present study. T-type CCBs performed a pooled improvement in creatinine clearance and glomerular filtration rate similar to ACEIs/ARBs but were inferior to ACEIs/ARBs on reducing proteinuria excretion （ three RCTs, 389 subjects, WMD 0. 26 g ·d^-1 , 95% CI 0. 10 to 0. 43 ） , although T-type CCBs and ACEIs/ARBs showed stable anti-hypertensive effect. CONCLUSION Our findings suggest that despite T-type CCBs do offer salutary effects on kidney outcomes and hypertension can be applied to treat hypertensive patients with chronic kidney disease, ACEIs/ARBs might be better choice for pressure control in this target population especially when proteinuria is the main issue of renal dysfunction.

关 键 词：T-型CCB ACEI ARB 高血压 慢性肾病 

分 类 号：R459.7[医药卫生—急诊医学]