Gu Jinjin, Han Lina, Liu Qiang
Department of Gerontology, Zhenjiang First People's Hospital, Zhenjiang Jiangsu, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2013 Jun;38(6):623-30. doi: 10.3969/j.issn.1672-7347.2013.06.012.
To evaluate the efficacy and safety of combined treatment with angiotensin II receptor blocker (ARB) and angiotensin converting enzyme inhibitor (ACEI) on diabetic kidney disease.
Randomized controlled trials (RCTs) were identified from CoChrane library, PubMed, EMbase, CNKI and VIP. Eleven RCTs involving 602 patients were included and analyzed with Rev Man 5.1 software.
Compared with ACEI alone, combined treatment with ARB and ACEI was more effective on decreasing 24 h albuminuria, systolic pressure, average 24 h systolic pressure, diastolic pressure, and average 24 h diastolic pressure but with a high level of serum potassium. Compared with ARB alone, combined treatment with ARB and ACEI was more effective on decreasing systolic pressure and diastolic pressure. Compared with ACEI or ARB alone, we didn't get a definite conclusion that whether combined treatment with ARB and ACEI was more effective on decreasing 24 h proteinuria.
Based on this Meta analysis, combined treatment with ARB and ACEI is safer and has positive effect on diabetic kidney disease. However, small sample size and low methodological quality appeared in most of the trials included in this systematic review. Therefore, available evidence is insufficient to recommend a routine clinical application of combined treatment with ARB and ACEI on diabetic kidney disease.
评估血管紧张素II受体阻滞剂（ARB）与血管紧张素转换酶抑制剂（ACEI）联合治疗糖尿病肾病的疗效及安全性。
从考克兰图书馆、PubMed、EMbase、中国知网和维普资讯中检索随机对照试验（RCT）。纳入11项涉及602例患者的RCT，并使用Rev Man 5.1软件进行分析。
与单用ACEI相比，ARB与ACEI联合治疗在降低24小时蛋白尿、收缩压、平均24小时收缩压、舒张压及平均24小时舒张压方面更有效，但血钾水平较高。与单用ARB相比，ARB与ACEI联合治疗在降低收缩压和舒张压方面更有效。与单用ACEI或ARB相比，关于ARB与ACEI联合治疗在降低24小时蛋白尿方面是否更有效，我们未得出明确结论。
基于此项Meta分析，ARB与ACEI联合治疗对糖尿病肾病更安全且有积极作用。然而，该系统评价纳入的大多数试验样本量小且方法学质量低。因此，现有证据不足以推荐ARB与ACEI联合治疗在糖尿病肾病中的常规临床应用。
