CAJ | 학술논문

目的系统评价他汀类药物治疗早期糖尿病肾病(DKD)的疗效.方法计算机检索Cochrane图书馆临床对照试验资料库(2009年第2期)、MEDLINE(1991～2009年8月)、EMbase(1991～2009年8月)、CBMdisc(1991～2009年8月)、CNKI(1994～2009年8月),手工检索相关文献,按纳入与排除标准选择随机对照试验(RCT).评价质量及提取资料后,采用RevMan 4.2软件对数据进行Meta分析.结果初检出 281篇文献,经筛选最终纳入22篇文献共25个RCT,包括1 838例患者.纳入文献总体质量不高,均为C级.由于各研究间存在异质性,故采用随机效应模型进行效应量合并.Meta分析结果显示,试验组尿白蛋白排泄率(UAER)[WMD=-55.77,95%CI(-74.20,-37.34),P<0.000 01]、血肌酐(Scr)[WMD=-4.34,95%CI(-6.74,-1.94),P=0.0004]、C反应蛋白(CRP)[WMD=-1.48,95%CI(-2.32,-0.63),P=0.006]、总胆固醇(TC)[WMD=-1.33,95%CI(-1.75,-0.91),P<0.00001]以及甘油三脂(TG)[WMD=-0.72,5%CI(-1.17,-0.27),P=0.002]较对照组均明显降低.倒漏斗图散点分布近似左右对称,提示纳入研究存在发表偏倚可能性小.纳入的22篇文献共报道12例患者出现转氨酶升高,经保肝治疗恢复正常,未见严重不良反应事件的报道.结论现有研究结果表明,他汀类药物在调节早期DKD患者血脂的同时,可以降低UAER和Scr,具有肾脏保护作用,其机制可能与降低血CRP水平有关,不良反应轻微.由于本研究纳入文献的质量缺陷,尚需更多高质量的随机双盲对照试验证实结论.
목적 계통평개타정류약물치료조기당뇨병신병(DKD)적료효.방법 계산궤검색Cochrane도서관림상대조시험자료고(2009년제2기)、MEDLINE(1991～2009년8월)、EMbase(1991～2009년8월)、CBMdisc(1991～2009년8월)、CNKI(1994～2009년8월),수공검색상관문헌,안납입여배제표준선택수궤대조시험(RCT).평개질량급제취자료후,채용RevMan 4.2연건대수거진행Meta분석.결과 초검출 281편문헌,경사선최종납입22편문헌공25개RCT,포괄1 838례환자.납입문헌총체질량불고,균위C급.유우각연구간존재이질성,고채용수궤효응모형진행효응량합병.Meta분석결과현시,시험조뇨백단백배설솔(UAER)[WMD=-55.77,95%CI(-74.20,-37.34),P<0.000 01]、혈기항(Scr)[WMD=-4.34,95%CI(-6.74,-1.94),P=0.0004]、C반응단백(CRP)[WMD=-1.48,95%CI(-2.32,-0.63),P=0.006]、총담고순(TC)[WMD=-1.33,95%CI(-1.75,-0.91),P<0.00001]이급감유삼지(TG)[WMD=-0.72,5%CI(-1.17,-0.27),P=0.002]교대조조균명현강저.도루두도산점분포근사좌우대칭,제시납입연구존재발표편의가능성소.납입적22편문헌공보도12례환자출현전안매승고,경보간치료회복정상,미견엄중불량반응사건적보도.결론 현유연구결과표명,타정류약물재조절조기DKD환자혈지적동시,가이강저UAER화Scr,구유신장보호작용,기궤제가능여강저혈CRP수평유관,불량반응경미.유우본연구납입문헌적질량결함,상수경다고질량적수궤쌍맹대조시험증실결론.
Objective To assess the effectiveness of statins in treating early diabetic kidney disease (DKD). Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2,2009),MEDLINE (1991 to August 2009),EMbase (1991 to August 2009),CBMdisc (1991 to August 2009) and CNKI (1994 to August 2009). We also handsearched relevant journals and conference proceedings. Randomized controlled trials (RCTs) in which statins were used to treat patients with early DKD were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria,evaluated the quality of the included studies,and performed meta-analyses by RevMan 4.2 software. Results A total of 281 articles were found and 22 articles inolving 1838 patients were finally included. All these articles were regarded as low quality. We chose the random-effect model to conduct meta-analysis because significant heterogeneities were found among these articles. The results of meta-analysis showed that after treatment with statins,there were significant reductions in urinary albumin excretion rate (UAER) (WMD= -55.77,95%CI -74.20 to -37.34,P<0.000 01),serum creatinine (Scr) (WMD= -4.34,95%CI -6.74 to -1.94,P=0.000 4),C reactive protein (CRP) (WMD= -1.48,95%CI -2.32 to -0.63,P=0.006),total cholesterol (TC) (WMD= -1.33,95%CI -1.75 to -0.91,P<0.000 01),and triglyceride (TG) (WMD= -0.72,95%CI-1.17 to -0.27,P=0.002) in group treatment compared with group control. Funnel-plot displayed a symmetrical figure,indicating there was no publication bias. No severe adverse effects were found in these articles except 12 patients with high level of transaminase which were cured after using hepatic protect therapy. Conclusion Currently available evidence shows that with the reduction of TC and TG,statins may decrease UAER and Scr in patients with early DKD and the reduction of CRP may be involved in the mechanism. Statins provide effective renal protection and no severe adverse effects in treating early DKD. However,due to lack of quality in the included studies,more studies of better quality should be conducted