【摘要】 目的 系统评价醛糖还原酶抑制剂(ARIs)治疗糖尿病心血管自主神经病变(DCAN)的有效性及安全性。 方法 以“Diabetes mellitus”，“ Cardiovascular autonomic neuropathy”，“ Aldose reductase inhibitor”为关键词，计算机检索Pubmed，Cochrane Library，EMbase，Medline等数据库，末次检索日期为2012年5月，根据入排标准全面收集相关文献，按Cochrane系统评价方法，评价纳入文献的方法学质量并提取相应数据采用RevMan 5.0软件进行Meta分析。 结果 最终共纳入10篇文献，Meta分析结果显示，ARIs与安慰剂相比，改善静息心率变异(WMD=0.25, P=0.04)、30:15比值(WMD=0.04, P=0.001)、立卧位收缩压变化(WMD=-5.94, P<0.00001)差异有统计学意义，未发现有明显的发表偏倚。除托瑞司他外，未见严重不良反应。 结论 ARIs治疗早期或亚临床期DCAN方面是有效的。

　　【关键词】 醛糖还原酶抑制剂;糖尿病;心血管自主神经病变;Meta分析

　　Meta-analysis: Aldose reductase inhibitor for diabetic cardiovascular autonomic neuropathy   HU Xin, LI Sheng-bing, CHEN Yong-yong, et al. Department of Endocrinology, The Second Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing 400010, China

　　Corresponding author: YANG Gang-yi, Email: gangyiyang@yahoo.com.cn

　　【Abstract】 Objective To assess the efficacy and safety of aldose reductase inhibitors (ARIs) on diabetic cardiac autonomic neuropathy. Methods Using “Diabetes mellitus”, “Cardiovascular autonomic neuropathy”, and “Aldose reductase inhibitor” as the key words, the computer retrieval was done in Pubmed, Cochrane Library, EMbase, and Medline to search for randomized or clinical controlled trials investigating ARIs for diabetic cardiac autonomic neuropathy. Additionally, the references of the articles returned by the search were examined for related publications. The deadline was May 2012. Methodological criteria and study results assessed by Cochrane were recorded on data extraction forms and the extracted data were processed with the software RevMan 5.0 for Meta analysis. Results Ten trials were enrolled for research. Publication bias was not found. Except E/I ratio, heterogeneity was also not found significant. Meta-analysis showed that comparing with placebo, ARIs could improve the resting heart rate variation coefficients (WMD=0.25, P=0.04), 30:15 radio (WMD=0.04, P=0.001), standing-supine systolic blood pressure changes (WMD=-5.94, P<0.00001), and the difference was statistically significant. Conclusion Except for tolrestat, ARIs were found effective and safe for mild or subclinical diabetic cardiac autonomic neuropathy.

　　【Key words】 Aldose reductase inhibitor;Diabetes mellitus;Cardiovascular autonomic neuropathy;Meta-analysis