Lovell H G
Cochrane Database Syst Rev. 2007 Jul 18(1):CD002183. doi: 10.1002/14651858.CD002183.pub2.
Renal disease is a serious complication of diabetes mellitus.
To examine whether the progression of early diabetic renal disease to end-stage renal failure may be slowed by the use of angiotensin converting enzyme inhibitors for reasons other than their antihypertensive properties, so that they have value in the treatment of normotensive diabetics with microalbuminuria.
Medline was searched for English language reviews and randomised controlled trials. Personal reference lists, and reference lists of retrieved studies were also used.
Randomised controlled trials with separate identifiable results for initially normotensive diabetic patients, who received angiotensin converting enzyme inhibitors for at least one year and were compared with controls.
Meta-analyses were performed on the results of 12 randomised controlled trials with a variety of patient inclusion and exclusion criteria. One further study met all conditions for inclusion but did not provide data in useable form for meta-analyses.
Albumin excretion rate fell for patients on angiotensin converting enzyme inhibition in 12 of the 13 studies but did so for only two of the 13 groups on placebo. Treatment provided a significant reduction in albumin excretion rate in both insulin dependent diabetes mellitus and non insulin dependent diabetes mellitus. Treatment with either captopril, enalapril or lisinopril reduced albumin excretion rate in comparison with control patients.A significantly greater lowering of blood pressure was experienced by initially normotensive patients in the angiotensin converting enzyme inhibitor than in the placebo group. Average glycosylated haemoglobin fell a little in the treated patients and rose in the controls, the difference being just significant. The difference in changes in glomerular filtration rate did not reach statistical significance.
AUTHORS' CONCLUSIONS: Inhibition of angiotensin converting enzyme can arrest or reduce the albumin excretion rate in microalbuminuric normotensive diabetics, as well as reduce or prevent an increase in blood pressure. But, given the drop in blood pressure in patients on angiotensin converting enzyme inhibitors, it is not certain that the reduction of albumin excretion rate is due to a separate renal effect. A direct link with postponement of end-stage renal failure has not been demonstrated. There appear to be no substantial side effects.
肾脏疾病是糖尿病的一种严重并发症。
研究血管紧张素转换酶抑制剂除降压特性外，是否因其其他原因减缓早期糖尿病肾病进展至终末期肾衰竭，从而使其在治疗伴有微量白蛋白尿的血压正常的糖尿病患者中具有价值。
检索Medline以查找英文综述和随机对照试验。也使用了个人参考文献列表以及检索到的研究的参考文献列表。
针对最初血压正常的糖尿病患者进行的随机对照试验，这些患者接受血管紧张素转换酶抑制剂治疗至少一年，并与对照组进行比较，且结果可单独识别。
对12项具有各种患者纳入和排除标准的随机对照试验结果进行荟萃分析。另有一项研究符合所有纳入条件，但未提供可用于荟萃分析的可用形式的数据。
13项研究中有12项研究显示，接受血管紧张素转换酶抑制治疗的患者白蛋白排泄率下降，而13项安慰剂组中只有2项出现这种情况。治疗使胰岛素依赖型糖尿病和非胰岛素依赖型糖尿病患者的白蛋白排泄率均显著降低。与对照患者相比，使用卡托普利、依那普利或赖诺普利治疗均可降低白蛋白排泄率。血管紧张素转换酶抑制剂组中最初血压正常的患者血压下降幅度明显大于安慰剂组。治疗组患者的糖化血红蛋白平均略有下降，而对照组则上升，差异具有统计学意义。肾小球滤过率变化的差异未达到统计学意义。
血管紧张素转换酶抑制可使伴有微量白蛋白尿的血压正常的糖尿病患者的白蛋白排泄率停止或降低，同时降低或预防血压升高。但是，鉴于使用血管紧张素转换酶抑制剂的患者血压下降，尚不确定白蛋白排泄率的降低是否归因于独立的肾脏效应。尚未证实与延缓终末期肾衰竭有直接联系。似乎没有明显的副作用。
