安體舒通治療糖尿病腎病的系統評價_《中國循證醫學雜志》

作者：

汪漢 ¹² , 張桂麗 ³ , 張全波 ¹ ,  鄧玨琳 ¹

1. 四川大學華西醫院老年科（成都 610041）；2. 鄖陽醫學院人民醫院老年科（十堰 442000）；3.鄖陽醫學院人民醫院美容科（十堰 442000）;

關鍵詞：

安體舒通糖尿病腎病隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20090015

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　評價醛固酮受體拮抗劑安體舒通治療糖尿病腎病的有效性及安全性。
方法　采用Cochrane系統評價方法，計算機檢索Cochrane圖書館臨床對照試驗資料庫（2008年第3期）、MEDLINE（1950～2008.8）、EMBASE（1984～2008.8）、CNKI（1994～2008.9）、VIP（1989～2008.8）；手工檢索相關會議論文集、藥廠資料及所有檢索到的文獻的參考文獻，納入安體舒通治療糖尿病腎病的隨機或半隨機試驗，評價納入研究的方法學質量，并提取有效數據進行分析。
結果　共納入3篇隨機對照試驗，但3篇研究存在臨床異質性，無法進行Meta分析，故僅進行描述性分析。RCT試驗證實安體舒通對于減少尿蛋白可能有一定作用，但是對于改善腎功能和降低血壓可能并無確切療效。
結論　據現有研究尚不能證實安體舒通是否對糖尿病腎病患者有效和安全，需要今后有大樣本、高質量的隨機對照試驗進一步證實。

引用本文： 汪漢,張桂麗,張全波,鄧玨琳. 安體舒通治療糖尿病腎病的系統評價. 中國循證醫學雜志, 2009, 09(1): 71-75. doi: 10.7507/1672-2531.20090015 復制

1.	American Diabetes Association. Position statement: Diabetic nephropathy. Diabetes Care, 1998, 21: S50.
2.	Collins AJ, Kasiske B, Herzog C, et al. Excerpts from the United States Renal Data System 2004 annual data report: atlas of endstage renal disease in the United States. American Journal of Kidney Diseases, 2005, 45(1 Suppl): A5-7.
3.	Gross JL, Silveiro SP, Canani LH, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005, 28(1): 164-176.
4.	Wu AY, Kong NC, Pan CY, et al. An alarmingly high revalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia, 2005, 48(1): 17-26.
5.	Kanwar YS, Akagi S, Sun L, et al. Cell biology of diabetic kidney disease. Experimental Nephrology, 2005, 101(3): e100-10.
6.	Lakkis J, Lu WX, Weir MR. RAAS escape: a real clinical entity that may be important in the progression of cardiovascular and renal disease. Curr Hypertens Rep, 2003, 5(5): 408-417.
7.	Struthers AD, MacDonald TM. Review of aldosterone-and angiotensinII- induced target organ damage and prevention. Cardiovascular Research, 2004, 61(4): 663-670.
8.	Schjoedt KJ, Rossing K, Juhl TR. Beneficial impact of spironolactone in diabetic nephropathy. Kidney international, 2005, 68(6): 2829-2836.
9.	Rossing K, Schjoedt KJ, Smidt UM. Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy: a randomized, double-masked, cross-over study. Diabetes care, 2005, 28(9): 2106-2112.
10.	Rachmani R, Slavachevsky I, Amit M. The effect of spironolactone, cilazapril and their combination on albuminuria in patients with hypertension and diabetic nephropathy is independent of blood pressure reduction: a randomized controlled study. Diabetic medicine, 2004, 21(5): 471-475.
11.	Takebayashi K, Matsumoto S, Aso Y, et al. Aldosterone blockade attenuates urinary monocyte chemoattractant protein-1 and oxidative stress in patients with type 2 diabetes complicated by diabetic nephropathy. Journal of Clinical Endocrinology & Metabolism, 2006, 91(6): 2214-2217.
12.	Anton H, Rini Baggen, Sacha Pauli. Spironolactone in type 2 diabetic nephropathy: effects on proteinuria, blood pressure and renal function. Journal of Hypertension, 2006, 24(11): 2285-2292.
13.	Mitch WE. Treating diabetic nephropathy--are there only economic issues? N Engl J Med, 2004, 351(19): 1934-1936.
14.	Parring HH, Osterby R, Anderson PW, et a1. Diabetic Nephropathy In Brenner BM Ed. The Kidney Philadelphia, 1996, 25(13): 1864-1892.
15.	Di Paolo S, Gesualdo L, Ranieri E, et al. High glucose concentration induces the overexpression of transfotruing growth factor- beta through the activation of platelet -derived growth factor loop in human mesangial cells. Am J Pathology, 1996, 149(6): 2095-2106.
16.	Schjoedt KJ, Andersen S, Rossing P, et al. Aldoster one escape during angiotensinⅡ receptor blockade in diabetic nephropathy is associated with enhanced decline in GFR. Diabetologia, 2004, 47(11): 1936-1939.
17.	Corry DB, Tuck ML. The effect of aldosterone on glucose metabolism. Current Hypertension Reports, 2003, 5(2): 106-109.
18.	Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 2000, 23(26 Suppl1): 4-19.
19.	Pitt B, Zannad F, RommeWJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med, 1999, 341(10): 709-717.

1. American Diabetes Association. Position statement: Diabetic nephropathy. Diabetes Care, 1998, 21: S50.
2. Collins AJ, Kasiske B, Herzog C, et al. Excerpts from the United States Renal Data System 2004 annual data report: atlas of endstage renal disease in the United States. American Journal of Kidney Diseases, 2005, 45(1 Suppl): A5-7.
3. Gross JL, Silveiro SP, Canani LH, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005, 28(1): 164-176.
4. Wu AY, Kong NC, Pan CY, et al. An alarmingly high revalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia, 2005, 48(1): 17-26.
5. Kanwar YS, Akagi S, Sun L, et al. Cell biology of diabetic kidney disease. Experimental Nephrology, 2005, 101(3): e100-10.
6. Lakkis J, Lu WX, Weir MR. RAAS escape: a real clinical entity that may be important in the progression of cardiovascular and renal disease. Curr Hypertens Rep, 2003, 5(5): 408-417.
7. Struthers AD, MacDonald TM. Review of aldosterone-and angiotensinII- induced target organ damage and prevention. Cardiovascular Research, 2004, 61(4): 663-670.
8. Schjoedt KJ, Rossing K, Juhl TR. Beneficial impact of spironolactone in diabetic nephropathy. Kidney international, 2005, 68(6): 2829-2836.
9. Rossing K, Schjoedt KJ, Smidt UM. Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy: a randomized, double-masked, cross-over study. Diabetes care, 2005, 28(9): 2106-2112.
10. Rachmani R, Slavachevsky I, Amit M. The effect of spironolactone, cilazapril and their combination on albuminuria in patients with hypertension and diabetic nephropathy is independent of blood pressure reduction: a randomized controlled study. Diabetic medicine, 2004, 21(5): 471-475.
11. Takebayashi K, Matsumoto S, Aso Y, et al. Aldosterone blockade attenuates urinary monocyte chemoattractant protein-1 and oxidative stress in patients with type 2 diabetes complicated by diabetic nephropathy. Journal of Clinical Endocrinology & Metabolism, 2006, 91(6): 2214-2217.
12. Anton H, Rini Baggen, Sacha Pauli. Spironolactone in type 2 diabetic nephropathy: effects on proteinuria, blood pressure and renal function. Journal of Hypertension, 2006, 24(11): 2285-2292.
13. Mitch WE. Treating diabetic nephropathy--are there only economic issues? N Engl J Med, 2004, 351(19): 1934-1936.
14. Parring HH, Osterby R, Anderson PW, et a1. Diabetic Nephropathy In Brenner BM Ed. The Kidney Philadelphia, 1996, 25(13): 1864-1892.
15. Di Paolo S, Gesualdo L, Ranieri E, et al. High glucose concentration induces the overexpression of transfotruing growth factor- beta through the activation of platelet -derived growth factor loop in human mesangial cells. Am J Pathology, 1996, 149(6): 2095-2106.
16. Schjoedt KJ, Andersen S, Rossing P, et al. Aldoster one escape during angiotensinⅡ receptor blockade in diabetic nephropathy is associated with enhanced decline in GFR. Diabetologia, 2004, 47(11): 1936-1939.
17. Corry DB, Tuck ML. The effect of aldosterone on glucose metabolism. Current Hypertension Reports, 2003, 5(2): 106-109.
18. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 2000, 23(26 Suppl1): 4-19.
19. Pitt B, Zannad F, RommeWJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med, 1999, 341(10): 709-717.

《中國循證醫學雜志》

安體舒通治療糖尿病腎病的系統評價

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《中國循證醫學雜志》

安體舒通治療糖尿病腎病的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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