【摘要】：目的:國內(nèi)外糖尿病患病率及發(fā)病率不斷升高,糖尿病腎病是其重要并發(fā)癥,嚴(yán)重影響公眾健康及經(jīng)濟(jì)負(fù)擔(dān),但目前藥物對(duì)糖尿病腎病療效不明確,為找到對(duì)糖尿病腎病安全有效的治療方法,我們對(duì)維生素D(Vitamin D VD)治療2型糖尿病腎病進(jìn)行系統(tǒng)評(píng)價(jià)。方法:計(jì)算機(jī)檢索“Pub Med、MEDLINE、CBM、CNKI”等數(shù)據(jù)庫及手工檢索1950年1月至2014年5月的相關(guān)文獻(xiàn)。根據(jù)納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)篩選維生素D對(duì)2型糖尿病腎病療效的隨機(jī)對(duì)照試驗(yàn)(Randomized controlled trials RCT),由兩名評(píng)價(jià)員獨(dú)立對(duì)納入的文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià)和提取相關(guān)數(shù)據(jù),包括尿蛋白定量、血肌酐、腎小球?yàn)V過率、超敏C反應(yīng)蛋白、血鈣濃度及不良反應(yīng)。該系統(tǒng)分析為計(jì)量資料,采用X2檢驗(yàn)進(jìn)行異質(zhì)性檢驗(yàn),用Rev Man5.0軟件進(jìn)行Meta分析,當(dāng)P值大于0.05采用固定效應(yīng)模型,小于0.05進(jìn)行亞組分析并采用隨機(jī)效應(yīng)模型。結(jié)果:最終納入15項(xiàng)隨機(jī)對(duì)照試驗(yàn),共計(jì)1036例患者,其中治療組522例,對(duì)照組512例。根據(jù)Cochrane評(píng)價(jià)手冊(cè)對(duì)納入文獻(xiàn)進(jìn)行3個(gè)等級(jí)評(píng)價(jià),其中1篇A級(jí)、1篇B級(jí)、13篇C級(jí)。Meta分析結(jié)果示:VD治療2型糖尿病腎病治療組與對(duì)照組比較,可分別減少2-3個(gè)月及6個(gè)月24小時(shí)尿蛋白定量(0.37%P=0.005)、(0.2%P0.00001),可降低超敏-C反應(yīng)蛋白(hs-CRP)(0.79%P0.00001),可升高6個(gè)月血鈣濃度,但對(duì)血肌酐的影響無明顯差異。8篇文獻(xiàn)報(bào)道了VD治療的不良反應(yīng),其中1篇發(fā)生高鈣血癥。結(jié)論:VD對(duì)2型糖尿病腎病有一定的療效,但因現(xiàn)有RCT研究質(zhì)量尚不夠高,故我們應(yīng)慎重對(duì)待本論文的結(jié)論,尚需要更多高質(zhì)量的RCT才能得出肯定結(jié)論。
[Abstract]:Objective: the prevalence and incidence of diabetes mellitus are increasing at home and abroad. Diabetic nephropathy is an important complication of diabetic nephropathy, which seriously affects public health and economic burden. However, the curative effect of drugs on diabetic nephropathy is not clear at present. In order to find a safe and effective treatment for diabetic nephropathy, we systematically evaluated the treatment of type 2 diabetic nephropathy with vitamin D (Vitamin D VD). Methods: Pub Med,MEDLINE,CBM,CNKI and other databases were searched by computer and related documents from January 1950 to May 2014 were searched manually. A randomized controlled trial (Randomized controlled trials RCT),) to screen the efficacy of vitamin D in the treatment of type 2 diabetic nephropathy according to the inclusion criteria and exclusion criteria was conducted by two evaluators to evaluate the quality of the literature included and to extract relevant data, including urine protein quantification. Serum creatinine, glomerular filtration rate, hypersensitive C reactive protein, serum calcium concentration and adverse reactions. X2 test was used for heterogeneity test and Rev Man5.0 software was used for Meta analysis. When P value was greater than 0. 05, fixed effect model was used, subgroup analysis was performed under 0. 05 and random effect model was used. Results: a total of 1036 patients were included in 15 randomized controlled trials, including 522 cases in the treatment group and 512 cases in the control group. According to the Cochrane evaluation manual, three grades of literature were evaluated, including one A, one B, 13 C. The results of Meta analysis showed that the treatment group of type 2 diabetic nephropathy treated with VD was compared with the control group. Urinary protein quantification (0.37%P=0.005), (0.2%P0.00001) and hypersensitive C-reactive protein (0.79%P0.00001) were reduced by 2-3 months and 6 months, respectively. The serum calcium concentration was increased for 6 months, but there was no significant difference in the effect of serum creatinine. The adverse reactions of VD treatment were reported in 8 articles, one of which developed hypercalcemia. Conclusion: VD has a certain curative effect on type 2 diabetic nephropathy, but the quality of existing RCT research is not high enough, so we should treat the conclusion of this paper with caution and need more high quality RCT in order to reach a positive conclusion.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊艷娜;張玉寶;方捷;袁丁;劉雯雯;;骨化三醇聯(lián)合替米沙坦治療糖尿病腎病的臨床效果[J];中國當(dāng)代醫(yī)藥;2014年04期

2 鄭學(xué)展;許義紅;;骨化三醇輔助治療糖尿病腎病療效觀察[J];海峽藥學(xué);2013年09期

3 周彬;趙燕;;骨化三醇聯(lián)合厄貝沙坦治療糖尿病腎病的效果[J];中國醫(yī)藥導(dǎo)報(bào);2013年24期

4 龐新華;;骨化三醇聯(lián)合替米沙坦治療糖尿病腎病的臨床療效觀察[J];中國現(xiàn)代醫(yī)生;2013年20期

5 周雪紅;劉曙艷;李勇峰;秦云霞;鄭麗麗;;阿法骨化醇聯(lián)合替米沙坦治療早期糖尿病腎病的臨床研究[J];中國糖尿病雜志;2012年09期

6 管紅斌;黃華;桓文穆;何凱平;汪斌;;骨化三醇聯(lián)合替米沙坦治療糖尿病腎病的療效[J];廣東醫(yī)學(xué);2012年16期

7 楊喜榮;賈小桃;;維生素D治療糖尿病腎病的臨床觀察[J];中國藥物與臨床;2012年04期

8 丁紅;湛川;王宗謙;李艷濃;閔睿;;骨化三醇對(duì)糖尿病腎病患者蛋白尿及高敏C反應(yīng)蛋白的影響[J];山東醫(yī)藥;2011年41期

9 徐鵬;張驊;;阿法骨化醇對(duì)2型糖尿病腎病患者微炎癥狀態(tài)的影響[J];中國全科醫(yī)學(xué);2011年15期

10 徐鵬;陳星華;;貝那普利和阿法骨化醇聯(lián)合治療糖尿病腎病的療效研究[J];中國全科醫(yī)學(xué);2010年29期

，

本文編號(hào)：2371462