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 for Diabetes Mellitus Combined with Hypertension and Renal Impairment: A Systematic Review

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

机构地区：[1]重庆医科大学附属永川医院全科医学科,重庆402160

出　　处：《中国循证医学杂志》2014年第10期1234-1240,共7页Chinese Journal of Evidence-based Medicine

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：目的系统评价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WanFang Data、CNKI、VIP、CBM、The Cochrane Library(2013年第10期)、PubMed、Ovid、MEDLINE和EMbase数据库,查找氨氯地平与缬沙坦比较治疗糖尿病合并高血压并发肾脏损害效果的随机对照试验(RCT),检索时限均为建库至2013年10月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入9个RCT,共计794例患者。Meta分析结果显示:氨氯地平改善24 h尿蛋白的效果优于缬沙坦[24 h尿蛋白基线值<1000 mg:WMD=–10.24,95%CI(–18.52,–1.95),P=0.02;24 h尿蛋白基线值>1000 mg:WMD=–575.69,95%CI(–781.02,–370.36),P<0.00001];而在改善尿蛋白排泄率(UAER)、血肌酐(Scr)、血压(SBP/SDP)及不良反应发生率方面,两者无明显差异[UAER:WMD=–11.29,95%CI(–27.93,5.36),P=0.18;Scr:WMD=1.05,95%CI(–3.89,5.99),P=0.68;SBP:WMD=0.52,95%CI(–0.83,1.87),P=0.45;DBP:WMD=–0.40,95%CI(–1.41,0.62),P=0.44;不良反应发生率:WMD=1.00,95%CI(0.3,3.34),P=1.00]。结论现有证据显示,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,在改善24 h尿蛋白效果方面优于缬沙坦。Objective To systematically review the efficacy of amlodipine versus valsartan in the treatment of dia- betes mellitus combined with hypertension and renal impairment. Methods All relevant randomized controlled trials （RCTs） were retrieved in WanFang Data, CNKI, VIP, CBM, The Cochrane Library （Issue 10, 2013）, PubMed, EMbase and Ovid up to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion crite- ria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. Results Nine RCTs were finally included involving 794 cases. The results of meta-analysis showed that am- lodipine was better than valsartan in improving 24-hour proteinuria （basic level 〈 1 000 rag： WMD= -10.24, 95%CI -18.52 to -1.95, P=0.02; basic level 〉1 000 mg： WMD= -575.69, 95%CI -781.02 to -370.36, P〈0.000 01）. However, there was no significant difference between two groups in lowing urine albumin excretion rates （UAER）, serum creatinine （Scr）, systol- ic blood pressure （SBP）, diastolic blood pressure （DBP）, and incidences of adverse events （UAER： WMD= -11.29, 95%CI -27.93 to 5.36, P=0.18; Scr： WMD=1.05, 95%CI -3.89 to 5.99, P=0.68; SBP： WMD=0.52, 95%CI -0.83 to 1.87, P=0.45; DBP： WMD= -0.40, 95%CI -1.41 to 0.62, P=0.44; ADR： WMD=1.00, 95%CI 0.3 to 3.34, P=1.00）. Conclusion Current evidence shows that, compared with valsartan, amlodipine has the same efficacy in treatment of diabetes mellitus com- bined with hypertension and renal impairment, and it is even better in improving 24-hour proteinuria.

关 键 词：氨氯地平 缬沙坦 糖尿病 高血压 肾脏损害 系统评价 Meta分析 随机对照试验 

分 类 号：R544.1[医药卫生—心血管疾病] R587.1[医药卫生—内科学]