【摘要】：目的:本研究通過(guò)對(duì)國(guó)內(nèi)外有關(guān)活性維生素D聯(lián)合血管緊張素轉(zhuǎn)換酶抑制劑(ACEI)或血管緊張素受體拮抗劑(ARB)治療糖尿病腎病的隨機(jī)對(duì)照實(shí)驗(yàn)進(jìn)行系統(tǒng)回顧和meta分析,探討在ACEI或ARB治療糖尿病腎病基礎(chǔ)上聯(lián)用活性維生素D的有效性和安全性。方法:應(yīng)用Cochrane系統(tǒng)評(píng)價(jià)方法,對(duì)Cochrane對(duì)照試驗(yàn)注冊(cè)數(shù)據(jù)庫(kù)、PUBMED、EMBASE、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、相關(guān)期刊論文(CNKI)、維普(VIP)、萬(wàn)方(Wanfang)自建庫(kù)以來(lái)至2015年1月的所有文獻(xiàn)進(jìn)行檢索。文獻(xiàn)語(yǔ)種為中文和英文。檢索出完全符合制定的納入標(biāo)準(zhǔn)的隨機(jī)對(duì)照試驗(yàn)并對(duì)其進(jìn)行質(zhì)量評(píng)價(jià),并使用Revman 5.12統(tǒng)計(jì)軟件對(duì)從文獻(xiàn)提取出的數(shù)據(jù)進(jìn)行Meta分析。結(jié)果:經(jīng)過(guò)檢索及嚴(yán)格篩選文獻(xiàn),最終8個(gè)隨機(jī)對(duì)照實(shí)驗(yàn)、共794例患者符合納入標(biāo)準(zhǔn)進(jìn)行meta分析研究,結(jié)果顯示:與單純使用ACEI/ARB組相比,ACEI/ARB聯(lián)合活性維生素D組顯著降低24小時(shí)尿蛋白[RR=-0.66,95%CI(-0.87,-0.46),P0.0001],但對(duì)糖化血紅蛋白(Hb A1c)[RR=-0.01,95%CI(-0.08,0.06),P=0.78]無(wú)影響;聯(lián)用活性維生素D治療不增加不良事件發(fā)生率[OR=1.28,95%CI(0.72,2.27),P=0.41]。結(jié)論:與單純使用ACEI或者ARB藥物相比,聯(lián)合使用活性維生素D能進(jìn)一步降低糖尿病腎病患者的24小時(shí)尿蛋白,且不增加不良反應(yīng)。該結(jié)果尚需大規(guī)模、多中心、前瞻性隨機(jī)對(duì)照試驗(yàn)加以證實(shí)。
[Abstract]:Objective: to study the effects of active vitamin D combined with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB) on diabetic nephropathy. To investigate the efficacy and safety of ACEI or ARB combined with active vitamin D in the treatment of diabetic nephropathy. Methods: using Cochrane system evaluation method, registered database of Cochrane controlled trials, PUBMED,EMBASE, database of Chinese biomedical literature, (CBM), full text database of Chinese periodicals, (CNKI), Weip (VIP), were used. Wanfang (Wanfang) has searched all the literatures since it was built up to January 2015. The languages of the literature are Chinese and English. A randomized controlled trial with complete compliance with the inclusion criteria was retrieved and its quality was evaluated, and the data extracted from the literature were analyzed by Meta using Revman 5.12 statistical software. Results: a total of 794 patients met the inclusion criteria for meta analysis in 8 randomized controlled trials after searching and screening the literature. The results showed that: compared with the ACEI/ARB group alone, 794 patients met the inclusion criteria. ACEI/ARB combined with active vitamin D significantly decreased 24 hour urinary protein [RR=-0.66,95%CI (-0.87- 0.46), P 0.0001], but the glycosylated hemoglobin (Hb A _ 1c) [RR=-0.01,95%CI (-0.08 ~ 0.06)], There was no effect on P0. 78; Combined use of active vitamin D did not increase the incidence of adverse events [OR=1.28,95%CI (0.72 鹵2.27), P < 0.41]. Conclusion: compared with ACEI or ARB alone, combined use of active vitamin D can further reduce 24 hour urine protein in patients with diabetic nephropathy without increasing adverse reactions. The results need to be confirmed by a large-scale, multi-center, prospective randomized controlled trial.
【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(lèi)號(hào)】：R587.2;R692.9

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