前列地尔联合氯沙坦治疗糖尿病肾病临床疗效的系统评价

摘要

目的：系统评价前列地尔联合氯沙坦治疗糖尿病肾病（ DN）的临床疗效。方法检索中文数据库和外文数据库关于前列地尔联合氯沙坦治疗DN的随机对照研究，检索年限从建库到2015年1月30日。治疗措施以为常规降糖等治疗基础上联合应用前列地尔、氯沙坦为治疗组，以常规治疗基础上单用前列地尔或氯沙坦为对照组。应用Cochrane评价员手册进行偏倚风险评价，Jadad评分法进行质量评价。如果纳入研究提供的数据不能进行Meta分析，则只进行描述性定性分析；如果能进行Meta分析，应用RevMan5．3软件进行Meta分析；评价两组临床疗效。结果符合纳入标准的研究共8项，DN患者584例。治疗组总有效率、24 h尿蛋白定量、24 h尿β2微球蛋白定量、尿白蛋白排泄率均优于对照组（P均＜0．05）。两组肌酐、尿素氮、血肌酐清除率、收缩压、空腹血糖比较无统计学差异（P均＞0．05）；均无严重不良反应报道。结论前列地尔联合氯沙坦治疗DN临床疗效确切，可减少尿蛋白，且安全性较好。%Objective To systematically evaluate the clinical efficacy of alprostadil combined with losartan in the treatment of diabetic nephropathy ( DN) .Methods Major Chinese database and foreign language database from the incep-tion of each database up to 30th January 2015 were electronically searched for the randomized clinical trials of alprostadil combined with losartan in the treatment of DN.Conventional hypoglycemic therapy combined with alprostadil and losartan was considered as the treatment group, conventional treatment combined with alprostadil or losartan was taken as the control group.The Cochrane risk of bias tool was used to assess the risk of bias.We assessed the quality of included studies using the Jadad rating scale.If the data included could not be used in the meta-analysis, then we used descriptive analysis;if the data included could be used in the meta-analysis, then the Cochrane Collaboration′s RevMan5.3 software was used for me-ta-analysis.Results Eight studies were included and they contained 584 DN patients.The total effective rate, 24-hour u-rinary albumin, 24-hour urinaryβ2 microglobulin and urinary albumin excretion rate of the treatment group were better than those of the control group (all P<0.05).No significant difference was found in the creatinine, urea nitrogen, creatinine clearance rate, systolic blood pressure and fasting blood glucose between these two groups (all P>0.05).All studies in-cluded did not report any adverse reactions.Conclusion Alprostadil combined with losartan in the treatment of diabetic nephropathy can significantly improve the clinical curative effect, reduce urinary protein and has good safety.