| 摘要: |
| 目的系统评价不同剂量的活性维生素D治疗糖尿病肾病的疗效。方法计算机检索中文数据库CBM、CNKI、中文万方数据库、维普数据库和英文数据库PubMed、MEDLINE等数据库，收集国内外有关活性维生素D联合ACEI/ARB治疗糖尿病肾病的随机对照试验（RCT），按Cochrane系统评价方法，评价纳入研究的方法学质量并提取有效数据，使用RevMan5.3统计软件进行Meta分析。结果共纳入20个随机对照试验（共1450例），其中治疗组856例，对照组594例。Meta分析结果显示：与单纯使用ACEI/ARB组相比，ACEI/ARB联合不同剂量（0.25滋g/d、0.50滋g/d、0.25~0.5滋g/d）活性维生素D组能够显著降低24h尿蛋白（MD=-0.46，P＜0.01）、（MD=-0.22，P＜0.01），可降低超敏C反应蛋白（MD=-0.63，P＜0.01）、（MD=-0.55，P＜0.01），但对血肌酐，钙离子浓度，糖化血红蛋白和肾小球滤过率无统计学差异。其中8篇文献提到有不良反应，但经过停药后均恢复正常。结论本系统评价显示，与单纯使用ACER/ARB相比，不同剂量的活性维生素D均对糖尿病肾病有一定的疗效，在临床上可从小剂量开始使用，对临床的使用有着一定的指导作用，但由于纳入文献质量不高，存在偏倚风险，应慎重对待本论文得出的结论，需要更多的随机对照试验来加以证实。 |
| 关键词: 活性维生素 D 糖尿病肾病 荟萃分析 |
| DOI：10.12056/j.issn.1006-2785.2017.40.1.2017-311 |
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| Efficacy of active vitamin D in treatment of diabetic nephropathy：a meta-analysis |
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Zhejiang Chinese Medicine University
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| Abstract: |
| Objective To evaluate the efficacy of active vitamin D in treatment of diabetic nephropathy. Methods The studies on the efficacy of active vitamin D in treatment of diabetic nephropathy were searched from Chinese VIP,WanFang Data, China National Knowledge Infrastructure,PubMed, Embase and Google Scholar databases and eligible data were extracted. RevMan5.3 software was used for statistical analysis. Results Twenty randomized controlled trials involving 1450 patients were included for data extraction and analysis. There were 856 cases in study group and 594 cases in control group. The results showed that compared to control group treated with ACEI/ARB, ACEI/ARB combined with different doses of active vitamin G
(0.25滋g/d,0.50μg/d, 0.25-0.5滋g/d) significantly decreased 24-h urinary protein (MD=-0.46, P ＜0.00001), (MD=-0.22, P ＜
0.0001); and the hypersensitive C-reactive protein (MD=-0.63, P=0.001), (MD=-0.55, P ＜0.0001). However, there was no significant difference in serum creatinine and calcium levels, glycosylated hemoglobin and glomerular filtration rate. The adverse reactions were mentioned in 8 studies,but all returned to normal after drug withdrawal. Conclusion Meta-analysis shows that active vitamin D can enhances the efficacy of ACEI/ARB in treatment of diabetic nephropathy. Due to the risk of bias which may exist in the included literatures, more randomized controlled trials are needed to confirm the conclusion. |
| Key words: Active vitamin D Diabetic nephropathy Meta-analysis |
