标题：强化血糖控制对糖尿病肾脏病变影响的Meta分析

      作者：曹 梅，陈春燕，李玉雯，李 伟，桂 莉
    (云南省第三人民医院内分泌科，云南 昆明 650011)

      卷次： 2012年23卷7期

      【摘要】 目的 本研究拟通过荟萃分析，评价强化血糖控制对糖尿病患者肾脏病变的影响。方法 制定原
始文献的纳入标准和检索策略，在Medline、EMBASE及Cochrane图书馆内进行相关的检索。所有比较强化控制
血糖和常规治疗对糖尿病患者肾脏病变影响的随机对照试验(RCTs)纳入分析。应用随机或固定效应模型处理
预后指标的相对危险度(RR)。结果 6项RCT符合纳入标准。与常规治疗比较，强化控制血糖可降低糖尿病患
者微量白蛋白尿(RR 0.73，95% CI 0.59~0.90；P<0.01)、白蛋白尿(RR 0.64，95% CI 0.55~0.75；P<0.001)和复合终点
事件(终末期肾病或因肾脏病死亡)(RR 0.47，95% CI 0.33~ 0.67；P<0.001)的发生率。但强化血糖控制明显增加糖
尿病患者严重低血糖事件的发生率(RR 1.86，95%CI 1.52~2.29；P<0.001)。结论 强化血糖控制较标准治疗能显
著降低糖尿病患者肾脏病变发生的危险性，但会增加严重低血糖事件发生的危险性。

      【关键词】 糖尿病肾脏病变；Meta分析；白蛋白尿；微量白蛋白尿

      【中图分类号】 R587.2 【文献标识码】 A 【文章编号】 1003—6350（2012）07—119—05<

br>Effect of intensive glucose control on the diabetic kidney disease: a meta-analysis of the randomized controlled
trial.
CAO Mei, CHEN Chun-Yan, LI Yu-Wen, LI Wei, GUI Li. The Third People's Hospital of Yunnan Province, Kunming
650011, Yunnan, CHINA

【Abstract】 Objective To assess the effect of intensive glucose control on the diabetic kidney disease in pa-
tients with diabetes mellitus. Methods Systematic searches of peer-reviewed publications were performed in MED-
LINE, EMBASE, and Cochrane Library Database. All the randomized controlled trials (RCTs) that compared the in-
cidence of microalbuminuria, albuminuria and end stage renal disease between intensive glucose control and standard
glycaemic control were eligible. The pooled Relative Risk (RR) for clinical outcomes was compiled using a ran-
dom-effects model. Heterogeneity was evaluated by sensitivity analysis. Results Six eligible studies were identi-
fied. Intensive glucose control was found to be associated with a significant 27% microalbuminuria risk reduction
(RR 0.73, 95% CI 0.59~0.90;P<0.01), 36% albuminuria (RR 0.64, 95% CI 0.55~0.75; P<0.001) and Fin 53% com-
posite outcome risk reduction of end stage renal disease and mortality (RR 0.47, 95% CI 0.33~0.67; P<0.001). But in-
tensive therapy could significantly increases the risk of severe hypoglycemia (RR 1.86, 95% CI 1.52~2.29; P<0.001).
Conclusion Overall, intensive comparison with standard glycaemic control significantly reduces the risk of diabetic
kidney disease, end stage renal disease events, and increases the risk of hypoglycemia.

      【Key words】 Diabetic kidney disease; Meta-analysis; Microalbuminuria; Albuminuria