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本文综合评价西尼地平和L-型钙通道阻滞剂(L-型CCB)对高血压患者肾脏功能的影响。我们采用了检索Pubmed、Embase、Google Scholar、CNKI、Science Direct、Ebsco、Springer、Ovid、Cochrane Library、Medline、维普和万方等数据库建库至2014年9月有关西尼地平和L-型CCB对肾脏功能影响的临床随机对照试验(RCT)文献。按Jadad质量标准对纳入文献进行独立评价并交叉核对,采用RevMan 5.3软件进行Meta分析。以血清肌酐值(SCr)、尿蛋白排泄量(UPE)、尿蛋白/肌酐比(UPCR)、估算的肾小球滤过率(eG FR)为指标,以用药前后指标变化百分率均数差值(mean difference,MD)及其95%可信区间(95%CI)进行综合评价。发现共纳入10篇质量较高RCT文献,采用随机效应或固定效应模型分析,结果显示:治疗后,西尼地平组较L-型CCB组更明显降低UPE,二者对UPE影响有显著区别(MD=–36.59,95%CI:–70.85,–2.33),西尼地平组较L-型CCB组更明显降低UPCR,二者对UPCR影响有显著区别(MD=–46.56,95%CI:–88.50,–4.62);而对SCr(MD=0.01,95%CI:–2.97,2.98)及eG FR(MD=1.56,95%CI:–0.19,3.31)的影响二组间无显著差异。由此可知,与L-型CCB相比,西尼地平更能有效减少尿蛋白的排泄,延缓蛋白尿发展进程,而对SCr及eG FR影响方面,二组间无明显差异。
This article evaluates the effects of cilnidipine and L-type calcium channel blocker (L-CCB) on renal function in hypertensive patients. We searched databases such as Pubmed, Embase, Google Scholar, CNKI, Science Direct, Ebsco, Springer, Ovid, Cochrane Library, Medline, VIP and Wanfang to September 2014 for cilnidipine and L- Impact of Renal Function in Clinical Randomized Controlled Trials (RCT) Literature. According to the Jadad quality standard, the included documents were independently evaluated and cross-checked. Meta-analysis was performed using RevMan 5.3 software. Serum creatinine (SCr), urinary protein excretion (UPE), urinary protein / creatinine ratio (UPCR), estimated glomerular filtration rate (eG FR) as indicators, before and after treatment index changes in the mean percentage difference (mean difference, MD) and its 95% confidence interval (95% CI). A total of 10 high-quality RCT articles were included and analyzed using random effects or fixed effect models. The results showed that UPE was significantly reduced in the cilnilanpine group compared with the L-CCB group after treatment, and the difference was statistically significant MD = -36.59, 95% CI: -70.85, -2.33). In the cilnidipine group, the UPCR was significantly lower than that in the L-CCB group. There was a significant difference between the two groups (MD = -46.56,95% CI: 88.50, -4.62). There was no significant difference between the two groups for the effects of SCr (MD = 0.01, 95% CI: -2.97, 2.98) and eG FR (MD = 1.56, 95% CI: -0.19, 3.31). Thus, compared with L-CCB, cilnidipine was more effective in reducing urinary protein excretion and delaying the progression of proteinuria, while there was no significant difference in the effects of SCr and eG FR between the two groups.