Hu Xin, Li Shengbing, Yang Gangyi, Liu Hua, Boden Guenther, Li Ling
Key Laboratory of Diagnostic Medicine (Ministry of Education) and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, China.
Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
PLoS One. 2014 Feb 12;9(2):e87096. doi: 10.1371/journal.pone.0087096. eCollection 2014.
Aldose reductase inhibitors (ARIs) can block the metabolism of the polyol pathway, and have been used to slow or reverse the progression of diabetic cardiovascular autonomic neuropathy (DCAN). The purpose of this study was to review the effectiveness and safety of ARIs in the treatment of DCAN as determined by five cardiac autonomic neuropathy function tests.
CENTRAL, MEDLINE, EMBASE, Scopus databases (inception to May 2012) were searched to identify randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) investigating ARIs for the treatment of DCAN with an English-language restriction. The data were analyzed using RevMan 5.0, and the heterogeneity between the trials was evaluated using the Cochrane's Q-test as well as the I² test. The type of model (random or fixed) used for analysis was based on heterogeneity. Weighted mean differences (WMD) with 95% confidence intervals (CI) were computed for the five cardiac automatic neuropathy function tests to evaluate the effects.
Ten articles met the prerequisites for this review. Analysis of the results showed that ARIs significantly improved function in at least three of the five automatic neuropathy tests, including the resting heart rate variation coefficients (WMD = 0.25, 95%CI 0.02 to 0.48, P = 0.040); the 30∶15 ratio (WMD = 0.06, 95%CI 0.01 to 0.10, P = 0.010) and the postural systolic blood pressure change (WMD = -5.94, 95%CI -7.31 to -4.57, P = 0.001). The expiration/inspiration ratio showed a marginally significant benefit (WMD = 0.05, 95%CI 0.00 to 0.09, P = 0.040). Glycaemic control was not significantly affected by ARIs. Adverse effects of ARIs except for Tolerestat were minimal.
Based on these results, we conclude that ARIs could ameliorate cardiac automatic neuropathy especially mild or asymptomatic DCAN but need further investigation.
醛糖还原酶抑制剂（ARIs）可阻断多元醇途径的代谢，已被用于延缓或逆转糖尿病性心血管自主神经病变（DCAN）的进展。本研究的目的是通过五项心脏自主神经病变功能测试来评估ARIs治疗DCAN的有效性和安全性。
检索CENTRAL、MEDLINE、EMBASE、Scopus数据库（建库至2012年5月），以识别研究ARIs治疗DCAN的随机对照试验（RCTs）和非随机对照试验（非RCTs），限定语言为英文。使用RevMan 5.0分析数据，并使用Cochrane's Q检验以及I²检验评估试验间的异质性。用于分析的模型类型（随机或固定）基于异质性。计算五项心脏自主神经病变功能测试的加权平均差（WMD）及其95%置信区间（CI）以评估效果。
十篇文章符合本综述的纳入标准。结果分析表明，ARIs在五项自主神经病变测试中至少三项显著改善了功能，包括静息心率变异系数（WMD = 0.25，95%CI 0.02至0.48，P = 0.040）；30∶15比值（WMD = 0.06，95%CI 0.01至0.10，P = 0.010）以及体位性收缩压变化（WMD = -5.94，95%CI -7.31至-4.57，P = 0.001）。呼气/吸气比值显示出边缘显著益处（WMD = 0.05，95%CI 0.00至0.09，P = 0.040）。ARIs对血糖控制无显著影响。除托瑞司他外，ARIs的不良反应极小。
基于这些结果，我们得出结论，ARIs可改善心脏自主神经病变，尤其是轻度或无症状的DCAN，但仍需进一步研究。
