血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂联用治疗糖尿病肾病的不良反应文献分析  

Literature analysis of adverse drug reactions of ACEI combining with ARB in the treatment of diabetic nephropathy

作　　者：何新军[1] 王思平[1] 

机构地区：[1]杭州市第三人民医院药剂科,杭州310009

出　　处：《中国临床药学杂志》2014年第1期39-45,共7页Chinese Journal of Clinical Pharmacy

摘　　要：目的探讨国内血管紧张素转换酶抑制剂(ACEI)与血管紧张素Ⅱ受体拮抗剂(ARB)联用治疗糖尿病肾病的安全性。方法通过检索中国知网(CNKI)、万方数据库、中文科技期刊数据库(维普)等文献数据库,收集2000年1月-2013年3月国内临床资料进行汇总、分析。结果 ACEI和ARB联用组842例患者引起药物不良反应(ADR)114例,ADR发生率低于单用ACEI组,差异有统计学意义(P<0.05),与单用ARB组相当,差异无统计学意义(P>0.05)。贝那普利联用氯沙坦ADR发生率和单用贝那普利或氯沙坦相当(P>0.05);贝那普利联用缬沙坦ADR发生率低于单用贝那普利组,差异有统计学意义(P<0.05),与缬沙坦相当(P>0.05);贝那普利联合缬沙坦咳嗽的发生率远远低于单用贝那普利组,差异有高度统计学意义(P<0.01)。ACEI和ARB联用组ADR临床表现以呼吸系统、神经系统、其他(高血钾、血肌酐升高)为主,分别占47.37%、29.82%、16.67%。结论 ACEI和ARB联用组ADR发生率相当于单用ARB组,低于单用ACEI组。贝那普利联用缬沙坦比联用氯沙坦更为安全,但限于研究数量及质量,以上结论仍需更多、更详实的数据及研究加以验证。AIM To explore the safety of angiotensin converting enzyme inhibitor （ACEI） combining with an- giotensin I] receptor antagonist （ARB） in the treatment of diabetic nephropathy. METHODS The clinical data of ad- verse drug reactions （ADRs） from January of 2000 to March of 2013 in China, collected by databases of CNKI, Wang- fang data and VIP information, were reviewed. RESULTS Of 842 patients receiving ACEI combining with ARB, 114 patients had ADRs involving ten clinical situations such as cough, dizziness, hyperpotassemia, and so on. The ADR in- cidences of combined use group were significantly lower than those of ACEI group （ P 〈 0.05）, but there were no signifi- cant differences compared with the ARB group （ P 〉 0.05）. The ADR incidences of those receiving benazepril combining with losartan were no significant differences compared with benazepril or losartan group （ P 〉 0.05）. The ADR inci- dences of those receiving benazepril combining with valsartan were significantly lower than benazepril group （ P 〈 0.05 ）, but there were no significant differences compared with valsartan group （ P 〉 0.05）. The cough incidences of those re- ceiving benazepril combining with valsartan were highly significant lower than benazepril group （ P 〈 0.01 ）. CONCLU- SION The ADR incidences of those receiving ACEI combining with ARB are significantly lower than ACEI group, but there are no significant differences compared with ARB group. Benazepril combining with valsartan in the treatment of di- abetic nephropathy is safer than combining with losartan. However, the conclusion above still needs to be further proved by more high-quality and large-scale clinical trials because of the limitation of quantity, scale and quality of the included studies.

关 键 词：血管紧张素转换酶抑制剂 血管紧张素Ⅱ受体拮抗剂 药物不良反应 肾病 Meta分析 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学]