The Research Of Combination Of ACEI And ARB Treatment For Diabetic Kidney Disease In The Early Stage

Objective:Diabetic kidney disease（DKD）is a microvascular complication caused by abnormal metabolism of diabetes,It is also the second leading cause of end stage renal disease.It is characterized by continuous proteinuria,progressive renal impairment and hypertension,Late progression can be severe renal function.A lot of research shows that,Urinary protein and hypertension are independent risk factors for renal damage,Therefore,reducing urinary protein excretion and controlling blood pressure can better protect the kidney and delay the pathological progress of DKD.A large number of studies have shown that RAAS（renin-angiotensin-aldosterone system）is closely related to the pathological progression of DKD.Angiotensin converting enzyme inhibition and angiotensin II receptor blocker,respectively,block different links of RAAS can reduce proteinuria,control blood pressure and delay the pathological progress of DKD.By collected and analyzed the clinical data of ARB single use in the treatment of diabetic kidney disease in the early stage of 2015-2016 in our school affiliated hospital and A Meta analysis was used to collect and analyze the randomized controlled trials of ACEI and ARB combined with/alone in the treatment of diabetic kidney disease in the early stage has obtained certain research results,To evaluate the clinical efficacy of ARB and angiotensin converting enzyme inhibitors and angiotensin receptor blockers in the treatment of early diabetic kidney disease.Methods:A total of 186 cases of early diabetic kidney disease were treated in the endocrinology department of our school affiliated hospital from January 2015 to January2016,which conforms to the diagnostic criteria of early diabetic kidney disease and excludes other diseases of the urinary system,The study cases treated with valsartan（ARB）were classified as treatment group,the orther were classified as the control group.Treatment for 6 months,The clinical parameters of the two groups before and after treatment were recorded:microalbumin（UALB）,serum creatinine（Cr）,blood urea nitrogen（BUN）and potassium（K⁺）,SPSS 18.0 statistical software was used for overall analysis and stratification analysis of all cases;A comprehensive search for the clinical randomized controlled trial of ACEI combined with ARB in the treatment of early diabetic kidney disease published at home and abroad from 2000 to 2017,The key words are Diabetic kidney diseases,angiotensin converting enzyme inhibitors（ACEI）,angiotensin receptor blockers（ARB）and microalbuminuria,Meta analysis was performed on 17 clinical randomized controlled trials（including 1620 patients）.Results:Clinical analysis results of valsartan in the treatment of early diabetic kidney disease:The analysis of Summary,the treatment group compared with before,microalbuminuria（UALB）decreased significantly,the difference was statistically significant（P<0.05）,other kidney function index change has no obvious difference,the control group were no statistical significance of the indicators change.Distinguish between gender analysis,the treatment group of male group and female group compared with before treatment,microalbuminuria（UALB）decreased significantly,the difference was statistically significant（P<0.05）,other kidney function index change has no obvious difference,the control group were no statistical significance of the indicators change.Distinguish between age analysis,the treatment group of under the age of 70 and above70 years compared with before treatment,microalbuminuria（UALB）decreased significantly,the difference was statistically significant（P<0.05）,other kidney function index change has no obvious difference,the control group were no statistical significance of the indicators change.Distinguish the course of analysis,The serum creatinine（Cr）of10 years the following set in treatment group was increased,the paired t test was statistically significant（P<0.05）,other kidney function index change has no obvious difference,the control group were no statistical significance of the indicators change,The treatment group of more than 10 years group compared with before treatment,microalbuminuria（UALB）decreased significantly,the difference was statistically significant（P<0.05）,other kidney function index change has no obvious difference,the control group were no statistical significance of the indicators change.Distinguish the analysis of degree of microalbuminuria,UALB 0-60mg·L^-11 group,the changes of the treatment group and control group were not statistically significant,UALB 60-200mg·L^-1group,treatment group compared with before,microalbuminuria（UALB）decreased significantly,the difference was statistically significant（P<0.05）,other kidney function index change has no obvious difference,the control group were no statistical significance of the indicators change;Meta analysis results of ACEI and ARB in the treatment of early diabetic kidney disease:Meta analysis of 24h microalbuminuria,joint vs ACEI group,combined MD（95%CI）was-35.89（-40.70,-31.07）,the difference was statistically significant;The joint group vs ARB,combined MD（95%CI）was-33.78（-38.74,-28.82）,the difference was statistically significant.Meta analysis of blood urea nitrogen,joint vs ACEI group,combined MD（95%CI）was-0.17（-0.42,0.09）,there was no statistically significant difference;The joint group vs ARB,combined MD（95%CI）was 0.07（-0.17,0.32）,there was no statistically significant difference.Meta analysis of serum creatinine,joint vs ACEI group,combined MD（95%CI）was 1.66（-0.41,3.72）,there was no statistically significant difference;The joint group vs ARB,combined MD（95%CI）was 0.54（-1.45,2.54）,there was no statistically significant difference.Meta analysis of the endogenous creatinine clearance,the joint group vs ACEI,combined MD（95%CI）was-1.49（-4.81,1.84）,there was no statistically significant difference;The joint group vs ARB,combined MD（95%CI）was-0.80（-4.06,2.45）,there was no statistically significant difference.Potassium meta analysis,joint vs ACEI group,combined MD（95%CI）was-0.01（-0.08,0.05）,there was no statistically significant difference;The joint group vs ARB,combined MD（95%CI）was-0.03（-0.10,0.03）,there was no statistically significant difference.Safety analysis,the joint group vs ACEI,Dry cough with RD（95%CI）was 0.75（0.39,1.45）,giddy merging RD（95%CI）was1.80（0.42,7.76）,low blood pressure consolidation RD（95%CI）was 0.77（0.17,3.55）,diarrhea merger RD（95%CI）was 1.07（0.07,17.49）,the overall merge RD（95%CI）was 1.20（0.72,2.01）,all safety indexes and overall differences were not statistically significant;And the joint group vs ARB,Giddy combined with RD（95%CI）was 1.29（0.59,2.85）,low blood pressure combined with RD（95%CI）was 0.67（0.11,4.13）,diarrhea combined with RD（95%CI）was 0.51（0.04,5.76）,and the overall combined RD（95%CI）was 1.63（0.97,2.74）.all safety indexes and overall differences were not statistically significant.Conclusions:The overall and stratification analysis of 186 cases of early diabetic kidney disease were analyzed,We can conclude that valsartan can significantly reduce urinary microalbumin in patients with early diabetic kidney disease and do not have obvious adverse drug reactions and other renal function changes;Through the Meta analysis of 17 clinical randomized controlled trial,we can think,compared with ACEI and ARB single use,ACEI and ARB combination can obviously reduce the microalbuminuria of early diabetic kidney disease patients,and none of them has obvious renal function change and increase the incidence of adverse drug reactions.