目的 用循证医学的方法评价金水宝联合血管紧张素受体阻滞剂(ARB)治疗糖尿病肾病(DN)的疗效.方法 检索国内外科技期刊数据库,纳入金水宝联合ARB治疗DN的随机对照试验,并进行Meta分析.结果 共纳入15项研究1 095例患者,联合用药组可显著降低糖尿病肾病患者的24 h尿蛋白定量[P<0.000 01;MD=-0.10(-0.14,-0.06)g/24 h],血肌酐[P=0.000 8;MD=-16.25(-25.76,-6.73)μmol/L],尿素氮[P=0.000 2;MD=-1.20(-1.83,-0.57)mmol/L],尿白蛋白排泄率[P=0.000 5;MD=-19.33(-30.30,-8.37)μg/L],N-乙酰-β-D-葡萄糖苷酶(NAG酶)[P<0.000 01;MD=-4.92(-6.03,-3.80)U/L],尿白蛋白/肌酐[P<0.000 01;MD=-21.56(-26.84,-16.29)mg/g].表明联合用药可显著降低患者总胆固醇[P=0.000 5;MD=-0.58(-0.91,-0.25)mmol/L],三酰甘油[P<0.000 01;MD=-0.40(-0.51,-0.28)mmol/L].结论 金水宝联合ARB较单用ARB可进一步改善DN患者的肾功能,并有降血脂的作用.

Objective To assess the effect of combined Jinshuibao (JSB) and angiotensin receptor blocker (ARB) on diabetic nephropathy (DN) by method of evidence based medicine. Methods Randomized controlled trials assessing the combined JSB and ARB therapy for DN were retrieved from the domestic and foreign periodicals of science and technology database, and included in this Meta-analysis. Results Fifteen RCT involving 1 095 patients were identified. The effect of combined JSB and ARB was better than that of ARB alone on the 24 h proteinuria [P < 0.000 01; MD = -0.10 (-0.14, -0.06) g/24 h], serum creatinine [P = 0.000 8; MD = -16.25 (-25.76, -6.73) μmol/L], urea nitrogen [P = 0.000 2; MD =-1.20 (-1.83, -0.57) mmol/L], urinary albumin excretion rate [P = 0.0005; MD = -19.33 (-30.30, -8.37) μg/L], NAG enzyme [P < 0.000 01; MD = -4.92 (-6.03, -3.80) U/L], and urinary albumin/creatinine [P < 0.000 01; MD = -21.56 (-26.84, -16.29) mg/g]. The results show that the effect of combined JSB and ARB was better than that of ARB alone on total cholesterol [P = 0.000 5; MD = -0.58 (-0.91, -0.25) mmol/L] and triglyceride [P < 0.000 01; MD = -0.40 (-0.51, -0.28) mmol/L]. Conclusion Combined JSB and ARB therapy can further improve the renal function and lower blood lipids in DN patients.