T2DM合并高血压患者肾脏保护药物治疗的推荐意见:基于指南/共识的系统综述  

Recommendations of drug therapy for renal protection in type 2 diabetic patients complicated with hypertension: a systemic review based on guidelines and expert consensuses

作　　者：耿莎莎[1] 李扬[1] 葛剑力[1] 刘玥[1] 陈昕 江华[1] Geng Shasha;Li Yang;Ge Jianli;Liu Yue;Chen Xin;Jiang Hua(Department of General Practice,Shanghai East Hospital,Tongji University School of Medicine,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院全科医学科,上海200120

出　　处：《中华全科医师杂志》2024年第5期480-486,共7页Chinese Journal of General Practitioners

基　　金：上海市卫生健康委员会卫生行业专项(202140248);上海市浦东新区卫生健康委员会卫生行业专项(PW2019E-4)。

摘　　要：目的系统分析国内外相关指南/共识中关于2型糖尿病(T2DM)合并高血压患者肾脏保护用药推荐意见。方法该研究为系统综述。检索2018年1月1日至2023年2月20日世界卫生组织网站、国际指南协作网、英国国家卫生与临床优化研究所、美国国立临床实践指南文库、医脉通、PubMed、Web of Science、中国知网、万方数据知识服务平台等数据库中与T2DM合并高血压患者肾脏保护药物治疗相关的指南/共识。纳入满足入排标准的指南/共识,提取其中关于T2DM合并高血压患者肾脏保护药物治疗的所有推荐意见,并进行归纳、总结。结果初步检索到文献8470篇,最终纳入12篇,其中指南10篇,共识2篇。降压药物中,各指南/共识一致推荐肾素-血管紧张素系统(RAS)抑制剂作为T2DM合并高血压患者肾脏保护治疗的一线药物,但各指南/共识推荐的血压目标值略有不同。降糖药物中,各指南/共识均推荐钠-葡萄糖共转运蛋白-2抑制剂(SGLT-2i)作为T2DM合并高血压患者肾脏保护治疗的一线药物,当血糖不达标或不宜使用SGLT-2i时,建议加用胰高血糖素样肽-1受体激动剂。结论目前的指南/共识推荐RAS抑制剂和SGLT-2i作为T2DM合并高血压患者肾脏保护治疗的一线药物。Objective To propose recommendations for renal protective drug therapy in type 2 diabetic(T2DM)patients complicated with hypertension based on clinical guidelines and expert consensuses.Methods This was a systematic review.The clinical guidelines and expert consensuses related to renal protective drug therapy for T2DM patients complicated with hypertension were searched from the websites of the World Health Organization,the Guidelines International Network(GIN),the National Institute for Health and Care Excellence(NICE),PubMed,Web of Science,China National Knowledge Infrastructure(CNKI),and Wanfang Data Knowledge Service Platform from January 1,2018 to February 20,2023.The quality of the guidelines and consensuses was evaluated and the related contents were extracted and analyzed.Results Among the 8470 records identified,10 guidelines and 2 expert consensuses met the inclusion criteria.Using the appraisal of guidelines for research and evaluationⅡ(AGREEⅡ)score,5 guidelines were rated as A-level recommendations,and 5 guidelines were rated as B-level recommendations.The expert consensuses were of high quality according to the Joanna Briggs Institute(JBI)expert consensus evaluation standard.All guidelines/consensuses consistently recommended inhibiting the renin-angiotensin system(RAS)inhibitors as the first-line treatment for renal protective antihypertensive therapy in diabetic patients with hypertension,but the target values of blood pressure were slightly different.For hypoglycemic drugs,sodium glucose cotransporter-2 inhibitors(SGLT-2i)were recommended as the first-line renal protective drug in patients who have not achieved individualized glycemic targets,no matter whether they used or not metformin and SGLT-2i treatment,long-acting GLP-1 RA was recommended.Conclusions RAS inhibitors and SGLT-2i are recommended as the first-line drugs for renal protective therapy in T2DM patients with hypertension.

关 键 词：糖尿病 2型 高血压 肾病 药物治疗 肾脏保护 

分 类 号：R544.1[医药卫生—心血管疾病] R587.2[医药卫生—内科学] R692[医药卫生—临床医学]