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目的用循证医学的方法评价金水宝联合血管紧张素受体阻滞剂(ARB)治疗糖尿病肾病(DN)的疗效。方法检索国内外科技期刊数据库,纳入金水宝联合ARB治疗DN的随机对照试验,并进行Meta分析。结果共纳入15项研究1 095例患者,联合用药组可显著降低糖尿病肾病患者的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]。表明联合用药可显著降低患者总胆固醇[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]。结论金水宝联合ARB较单用ARB可进一步改善DN患者的肾功能,并有降血脂的作用。
Objective To evaluate the efficacy of Jinshuibao combined with angiotensin receptor blocker (ARB) in the treatment of diabetic nephropathy (DN) by evidence-based medicine. METHODS: The databases of domestic and foreign sci-tech periodicals were searched, randomized controlled trials of Jin-Bao combined with ARB in the treatment of DN were conducted and analyzed by Meta-analysis. Results A total of 1 095 patients were enrolled in 15 studies. The combination therapy group significantly reduced 24 h urinary protein in patients with diabetic nephropathy (P <0.000 01; MD = -0.10 (-0.14, -0.06) g / 24 h) Creatinine (P = 0.0008; MD = -16.25 (-25.76, -6.73) μmol / L], urea nitrogen [P = 0.0002; MD = -1.20 (-1.83, -0.57) mmol / L] (P = 0.0005; MD = -19.33 (-30.30, -8.37) μg / L], NAGase [P <0.000 01; MD = -4.92 -6.03, -3.80) U / L], urinary albumin / creatinine [P <0.000 01; MD = -21.56 (-26.84, -16.29) mg / g]. The results showed that combination therapy could significantly reduce the total cholesterol (P = 0.0005; MD = -0.58 (-0.91, -0.25) mmol / L], triglyceride [P <0.000 01; MD = -0.40 (-0.51, -0.28 ) mmol / L]. Conclusions Jinshuibao combined with ARB can improve the renal function of DN patients and have the effect of lowering blood fat compared with ARB alone.