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目的 :对血管紧张素转换酶抑制剂 (ACEI)能否延缓血压正常的早期糖尿病肾病 (diabetic nephropathy,DN)患者的病情进展进行系统评价。 方法 :检索 MEDL INE及中国生物医学文献数据库中收录的 1990年 1月至 1999年 4月间 ,有关ACEI对伴微量白蛋白尿的早期 DN治疗作用的随机对照临床试验方面的文献。按照入选标准 ,最终有 10项随机对照临床试验纳入本研究。用 Rev Man3.1软件对 10项随机对照临床试验的结果进行合并。结果 :尿微量白蛋白排泄率、收缩压、舒张压、平均动脉压的合并效应分别为 - 77.5 0 2 m g/ 2 4h[- 10 0 .748,- 5 4.2 5 6 ],- 5 .0 0 2 mm Hg[- 9.6 30 ,- 0 .6 85 ](1m m Hg=0 .133 k Pa) ,- 2 .949mm Hg[- 4.0 0 5 ,- 1.892 ],- 4.2 84m m Hg[- 5 .44 4,- 3.12 3],P值均小于 0 .0 5。以发展至临床蛋白尿为终点 ,合并的优势比 OR(odds ratio)值为 0 .2 7[0 .18,0 .40 ]。亚组分析表明 ,以上结果的合并效应在 型和 型糖尿病患者中无明显差异 ,直线相关分析未发现尿微量白蛋白排泄率与收缩压、舒张压及平均动脉压的治疗效应之间有显著相关性。 结论 :对血压正常的早期 DN患者 ,ACEI可降低尿微量白蛋白的排泄率 ,延缓由 DN早期向临床蛋白尿期的进展 ,且此作用可能并不依赖于其降压效应。
AIM: To systematically evaluate whether angiotensin-converting enzyme inhibitor (ACEI) can delay the progression of normotensive diabetic nephropathy (DN). METHODS: We searched MEDL INE and the literature on randomized controlled clinical trials of ACEI in the treatment of early DN with microalbuminuria from January 1990 to April 1999 included in the Chinese Biomedical Literature Database. According to the inclusion criteria, finally 10 randomized controlled clinical trials were included in this study. The results of 10 randomized controlled clinical trials were combined using Rev Man 3.1 software. Results: The combined effects of urinary albumin excretion rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were-77.5 0 2 mg / 2 4h [- 10 0 .748, -5 52 5 6], -5.0 0 2 mm Hg [-9.6 30, -0.66 85] (1 m Hg = 0.133 Pa), -2.994 mm Hg [-4.050, -1.892], -4.24 mcm Hg [-5. 44 4, - 3.12 3] with P values less than 0.05. To develop to clinical proteinuria as the end point, the odds ratio (OR) was 0.27 [0 .18,0. 40]. Subgroup analysis showed that the combined effect of the above results in patients with type and type of diabetes no significant difference between the linear correlation analysis did not find urinary albumin excretion rate and systolic blood pressure, diastolic blood pressure and mean arterial pressure were significantly related to the therapeutic effect Sex. CONCLUSION: ACEI can decrease the urinary albumin excretion rate and delay the progression from early DN to clinical proteinuria in patients with normal normotensive DN. And this effect may not depend on its antihypertensive effect.