氨氯地平治疗糖尿病合并高血压并发肾脏损害效果的系统评价  

Efficacy of amlodipine on renal involvement complicated by diabetes mellitus with hypertension ： a systematic review

作　　者：胡乾配 谢波[1] 李一梅[1] 江莲[1] 罗天勇[1] 韩琳娜[1] 李琼[1] 

机构地区：[1]重庆医科大学附属永川医院全科医学科,402160

出　　处：《科学咨询》2014年第29期20-23,共4页

基　　金：重庆医科大学附属永川医院科研基金一般项目（编号：201008）.

摘　　要：目的采用系统评价方法，研究氨氯地平与缬沙坦相比治疗糖尿病合并高血压并发肾脏损害的效果。方法计算机检索万方、CNKI、VIP、CBM、Cochrane Library、PubMed、EMbase、OVID等数据库；Cochrane Library检索至2013年第10期，余数据库检索时限为建库至2013年10月，手工检索会议文献及杂志。按照Cochrane系统评价方法，由2名研究人员独立评价文献，核对纳入研究的质量评价及提取的有效数据，用RevMan5．2软件进行Meta分析。结果最终纳入9篇随机对照试验文献，其中中文7篇，英文2篇。Meta分析结果显示，氨氯地平改善UAER、24h尿蛋白的效果优于缬沙坦：UAER：WMD=-16．65，95％CI（-18．05，一15．25），P〈0．00001；24h尿蛋白：A组：WMD=-10．24，95％CI（一18．52，一1．95），P=0．02；B组：WMD=575．69，95％CI（-781．02，-370．36），P〈0．00001；而在改善血肌酐、血压及不良反应发生率方面，两者无显著性差异：血肌酐：WMD=1．05，95％CI（一3．89，5．99），P=0．68；SBP：WMD=0．21，95％CI（-0．91，1．33），P=0．71；DBP：WMD=一0．11，95％CI（-0．90，0．68），P=0．78；不良反应发生率：WMD=1．00，95％CI（0．3，3．34），P=1．00。结论与缬沙坦相比，氨氯地平对治疗糖尿病合并高血压并发的肾脏损害同样有效，在临床上可作为一线药物选用。Objective To systematically review the efficacy of amlodipine compared with valsartan in treatment of renal involvement complicated by diabetes mellitus with hypertension.Methods All relevant literatures were retrieved from database of Wanfang, CNKI, VIP, CBM, Cochrane Library, PubMed, EMbaseand OVID up to November 2013. Papers of related conference and magazine were also searched manually. With the evaluation method recommended by Cochrane Collaboration, two reviewers assessed the quality of the searched literatures and extracted data from the included studies. Meta-analysis was conducted using RevMan 5.2. Results Nine randomized controlled trials were finally included. Of them, seven were Chinese and the remaining two were English. The meta-analysis showed that amlodipine improving urine albumin excretion rate（UAER） was better than valsartan [WMD=-16. 65, 95%CI （-18. 05, -15.25）, P〈0. 00001 ] . However, there was no significant difference in lowing systolic blood pressure（SBP）, diastolic blood pressure（DBP）,24-hour proteinuria, Serum creatinine（Scr） and incidence of adverse events [SBP： WMD=0. 21mmag, 95 %CI （-0. 91, 1.33）, P=0. 71. DBP： WMD=-0. 11 mlHg, 95 %CI （-0. 90, 0. 68）, P=0. 78. 24-hour proteinuria： WMD=- 21.03, 95 %CI （-54.01, 11.94）, P=0. 21. Scr： WMI=1. 05, 95 %CI （-3. 89, 5. 99）, P=0. 68. Incidence of adverse events： WMI=1. 00, 95 % CI （0. 3, 3. 34）, P=1. 00 ] . Conclusion Compared with valsartan, ainlodipine has the same efficacy and safety in treatment of renal involvement complicated by diabetes mellitus with hypertension. Therefore, amlodipine can be used as first-line drugs.

关 键 词：氨氯地平 缬沙坦 糖尿病 高血压 肾脏损害 系统评价 

分 类 号：TQ460.6[化学工程—制药化工]