T型钙通道阻滞剂对高血压患者肾功能和醛固酮的影响：一项系统评价和荟萃分析
Effects of T-type calcium channel blockers on renal function and aldosterone in patients with hypertension: a systematic review and meta-analysis.
作者信息
Li Xue, Yang Mao Sheng
机构信息
Department of Pharmacology, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.
出版信息
PLoS One. 2014 Oct 17;9(10):e109834. doi: 10.1371/journal.pone.0109834. eCollection 2014.
BACKGROUND
High blood pressure can cause kidney damage, which can increase blood pressure, leading to a vicious cycle. It is not clear whether the protective effects of T-type calcium channel blockers (T-type CCBs) on renal function are better than those of L-type CCBs or renin-angiotensin system (RAS) antagonists in patients with hypertension.
METHODS AND FINDINGS
PUBMED, MEDLINE, EMBASE, OVID, Web of Science, Cochrane, CNKI, MEDCH, VIP, and WANFANG databases were searched for clinical trials published in English or Chinese from January 1, 1990, to December 31, 2013. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated and reported. A total of 1494 reports were collected, of which 24 studies with 1,696 participants (including 809 reports comparing T-type CCBs versus L-type CCBs and 887 reports comparing T-type CCB versus RAS antagonists) met the inclusion criteria. Compared with L-type CCBs, T-type CCBs resulted in a significant decline in aldosterone (mean difference = -15.19, 95% CI -19.65 - -10.72, p<1×10(-5)), proteinuria (mean difference = -0.73, 95% CI -0.88 - -0.57, p<1×10(-5)), protein to creatinine ratio (mean difference = -0.22, 95% CI -0.41 - -0.03, p = 0.02), and urinary albumin to creatinine ratio (mean difference = -55.38, 95% CI -86.67 - -24.09, p = 0.0005); no significant difference was noted for systolic blood pressure (SBP) (p = 0.76) and diastolic blood pressure (DBP) (p = 0.16). The effects of T-type CCBs did not significantly differ from those of RAS antagonists for SBP (p = 0.98), DBP (p = 0.86), glomerular filtration rate (p = 0.93), albuminuria (p = 0.97), creatinine clearance rate (p = 0.24), and serum creatinine (p = 0.27) in patients with hypertension.
CONCLUSION
In a pooled analysis of data from 24 studies measuring the effects of T-type CCBs on renal function and aldosterone, the protective effects of T-type CCBs on renal function were enhanced compared with L-type CCBs but did not differ from RAS antagonists. Their protective effects on renal function were independent of blood pressure.
背景
高血压可导致肾损害，而肾损害又会使血压升高，从而形成恶性循环。目前尚不清楚在高血压患者中，T型钙通道阻滞剂（T型CCB）对肾功能的保护作用是否优于L型CCB或肾素-血管紧张素系统（RAS）拮抗剂。
方法与结果
检索了PUBMED、MEDLINE、EMBASE、OVID、Web of Science、Cochrane、CNKI、MEDCH、VIP和万方数据库，查找1990年1月1日至2013年12月31日期间发表的英文或中文临床试验。计算并报告加权平均差（WMD）和95%置信区间（CI）。共收集到1494篇报告，其中24项研究共1696名参与者（包括809篇比较T型CCB与L型CCB的报告以及887篇比较T型CCB与RAS拮抗剂的报告）符合纳入标准。与L型CCB相比，T型CCB可使醛固酮显著下降（平均差=-15.19，95%CI -19.65 - -10.72，p<1×10⁻⁵）、蛋白尿（平均差=-0.73，95%CI -0.88 - -0.57，p<1×10⁻⁵）、蛋白肌酐比（平均差=-0.22，95%CI -0.41 - -0.03，p=0.02）以及尿白蛋白肌酐比（平均差=-55.38，95%CI -86.67 - -24.09，p=0.0005）；收缩压（SBP）（p=0.76）和舒张压（DBP）（p=0.16）无显著差异。对于高血压患者，T型CCB在SBP（p=0.98）、DBP（p=0.86）、肾小球滤过率（p=0.93）、蛋白尿（p=0.97）、肌酐清除率（p=0.24）和血清肌酐（p=0.27）方面的效果与RAS拮抗剂无显著差异。
结论
在对24项研究测量T型CCB对肾功能和醛固酮影响的数据进行的汇总分析中，T型CCB对肾功能的保护作用相较于L型CCB有所增强，但与RAS拮抗剂无差异。其对肾功能的保护作用独立于血压。
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