目的 用循證醫(yī)學(xué)的方法評(píng)價(jià)金水寶聯(lián)合血管緊張素受體阻滯劑(ARB)治療糖尿病腎病(DN)的療效.方法 檢索國(guó)內(nèi)外科技期刊數(shù)據(jù)庫(kù),納入金水寶聯(lián)合ARB治療DN的隨機(jī)對(duì)照試驗(yàn),并進(jìn)行Meta分析.結(jié)果 共納入15項(xiàng)研究1 095例患者,聯(lián)合用藥組可顯著降低糖尿病腎病患者的24 h尿蛋白定量[P<0.000 01;MD=-0.10(-0.14,-0.06)g/24 h],血肌酐[P=0.000 8;MD=-16.25(-25.76,-6.73)μmol/L],尿素氮[P=0.000 2;MD=-1.20(-1.83,-0.57)mmol/L],尿白蛋白排泄率[P=0.000 5;MD=-19.33(-30.30,-8.37)μg/L],N-乙酰-β-D-葡萄糖苷酶(NAG酶)[P<0.000 01;MD=-4.92(-6.03,-3.80)U/L],尿白蛋白/肌酐[P<0.000 01;MD=-21.56(-26.84,-16.29)mg/g].表明聯(lián)合用藥可顯著降低患者總膽固醇[P=0.000 5;MD=-0.58(-0.91,-0.25)mmol/L],三酰甘油[P<0.000 01;MD=-0.40(-0.51,-0.28)mmol/L].結(jié)論 金水寶聯(lián)合ARB較單用ARB可進(jìn)一步改善DN患者的腎功能,并有降血脂的作用.

Objective To assess the effect of combined Jinshuibao (JSB) and angiotensin receptor blocker (ARB) on diabetic nephropathy (DN) by method of evidence based medicine. Methods Randomized controlled trials assessing the combined JSB and ARB therapy for DN were retrieved from the domestic and foreign periodicals of science and technology database, and included in this Meta-analysis. Results Fifteen RCT involving 1 095 patients were identified. The effect of combined JSB and ARB was better than that of ARB alone on the 24 h proteinuria [P < 0.000 01; MD = -0.10 (-0.14, -0.06) g/24 h], serum creatinine [P = 0.000 8; MD = -16.25 (-25.76, -6.73) μmol/L], urea nitrogen [P = 0.000 2; MD =-1.20 (-1.83, -0.57) mmol/L], urinary albumin excretion rate [P = 0.0005; MD = -19.33 (-30.30, -8.37) μg/L], NAG enzyme [P < 0.000 01; MD = -4.92 (-6.03, -3.80) U/L], and urinary albumin/creatinine [P < 0.000 01; MD = -21.56 (-26.84, -16.29) mg/g]. The results show that the effect of combined JSB and ARB was better than that of ARB alone on total cholesterol [P = 0.000 5; MD = -0.58 (-0.91, -0.25) mmol/L] and triglyceride [P < 0.000 01; MD = -0.40 (-0.51, -0.28) mmol/L]. Conclusion Combined JSB and ARB therapy can further improve the renal function and lower blood lipids in DN patients.