Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Kidney Int. 2012 Apr;81(7):674-83. doi: 10.1038/ki.2011.413. Epub 2011 Dec 21.
Renin-angiotensin-aldosterone system inhibitors prevent the progression of kidney disease in patients with diabetic nephropathy, and we studied how that benefit varies by the type of diabetes and baseline urinary albumin. We pooled data from 49 randomized controlled trials in a meta-analysis using the ratio of endpoint urinary albumin levels in those treated compared to those untreated with renin-angiotensin-aldosterone system inhibitors in both fixed- and random-effects models. The urinary albumin excretion for treated microalbuminuric patients with Type 1 diabetes was on average 60% lower at the end of the trial compared with patients not treated with renin-angiotensin-aldosterone system inhibitors using the fixed-effects model and 67% lower using the random-effects model. There was no significant effect of treatment in patients with normal albumin excretion. For normoalbuminuric patients with Type 2 diabetes, urinary albumin excretion was on average 12% lower after treatment using the fixed-effects model compared to 21% lower using the random-effects model. For microalbuminuric patients, urinary albumin excretion was on average 23% lower using the fixed-effects model and 27% lower using the random-effects model. Thus, renin-angiotensin-aldosterone system inhibition reduced urinary albumin excretion for Type 1 diabetic patients with micro-, but not those with normoalbuminuria. Treatment reduced urinary albumin excretion for Type 2 diabetic patients with and without microalbuminuria.
肾素-血管紧张素-醛固酮系统抑制剂可预防糖尿病肾病患者的肾脏疾病进展，我们研究了这种益处如何因糖尿病类型和基线尿白蛋白而有所不同。我们使用固定效应和随机效应模型，对 49 项随机对照试验的数据进行荟萃分析，比较了治疗组和未治疗组的终点尿白蛋白水平比值。与未使用肾素-血管紧张素-醛固酮系统抑制剂治疗的患者相比，1 型糖尿病微量白蛋白尿患者的尿白蛋白排泄量在试验结束时平均降低了 60%（使用固定效应模型）和 67%（使用随机效应模型）。在白蛋白正常排泄的患者中，治疗无显著效果。对于 2 型糖尿病的正常白蛋白尿患者，与使用固定效应模型相比，治疗后尿白蛋白排泄量平均降低了 12%，而使用随机效应模型则降低了 21%。对于微量白蛋白尿患者，使用固定效应模型平均降低了 23%，使用随机效应模型则降低了 27%。因此，肾素-血管紧张素-醛固酮系统抑制剂可降低 1 型糖尿病微量白蛋白尿患者的尿白蛋白排泄量，但对正常白蛋白尿患者无效。治疗可降低 2 型糖尿病有和无微量白蛋白尿患者的尿白蛋白排泄量。
