α-酮酸片联合低蛋白饮食治疗糖尿病肾脏病临床疗效的Meta分析  

Meta-analysis of the clinical efficacy of compound α-ketoacid tablets combined with low-protein diet in diabetic kidney disease

作　　者：曹玲艳 钟华琛 毕丹青[1] 何佳敏 李昌彦 樊文星[1] Cao Lingyan;Zhong Huachen;Bi Danqing;He Jiamin;Li Changyan;Fan Wenxing(Department of Nephrology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Infection,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院肾脏内科,650032 [2]昆明医科大学第一附属医院感染科,650032

出　　处：《中华临床营养杂志》2023年第3期161-171,共11页Chinese Journal of Clinical Nutrition

基　　金：国家自然科学基金地区基金项目(82160142);云南省科技厅-昆明医科大学应用基础研究联合专项资金项目杰出青年培育项目(202201AY070001-044);云南省中青年学术和技术带头人后备人才项目(202205AC160062)。

摘　　要：目的系统评价复方α-酮酸片治疗糖尿病肾脏病(diabetic kidney disease, DKD)的临床疗效。方法检索CNKI、万方数据库、EMBASE、PubMed、Cochrane.Library数据库。纳入从建库开始起至2022年11月13日所有符合入选条件的文献。评价纳入的文献质量和提取有效信息后采用RevMan 5.3软件进行相关数据的Meta分析。结果共纳入26项随机对照临床试验, 共2 790例患者, 试验组1 465例, 对照组1 325例。两组间24 h尿蛋白、血肌酐、尿素氮、营养指标、相关细胞因子、空腹血糖、糖化血红蛋白、收缩压、血清同型半胱氨酸、肝细胞生长因子、血管内皮细胞生长因子、转化生长因子-β1指标较对照组明显改善, 差异有统计学意义。结论有限且低质量的证据指出, 复方α-酮酸片联合低蛋白饮食可能与DKD患者中改善的24 h尿蛋白、肾功能、糖代谢有关。但目前尚缺少针对DKD各阶段设计的随机对照试验, 导致该研究纳入标准较宽, 结果缺乏针对性, 某些指标各组间异质性明显, 且随访时间较短, 仍需要更多高质量、多中心、大样本的随机对照试验进行证实。Objective To systematically evaluate the clinical efficacy of compoundα-ketoacid tablets in the treatment of diabetic kidney disease(DKD).Methods CNKI,Wanfang database,EMBASE,PubMed and Cochrane Library database were searched for eligible records published from the establishment of individual database to November 13th,2022.The quality of the included studies were assessed,data were extracted,and meta-analysis was conducted using RevMan5.3.Results A total of 26 randomized controlled trials were included,with a total of 2790 DKD patients(1465 in the experimental group and 1325 in the control group).Multiple parameters were significantly improved in the experimental group compared with the control group,including 24-hour urinary protein,blood creatinine,urea nitrogen,nutritional index,oxidative stress level,fasting blood glucose,glycated hemoglobin,homocysteine,HGF,VEGF,TGF-β1,and systolic blood pressure.Conclusions Limited low-quality evidence showed that compoundα-ketoacid tablets combined with low-protein diet may be related to the improved 24-hour urinary protein,renal function,and glucose metabolism in patients with DKD.Due to the lack of randomized controlled trials designed for respective stages of DKD,the inclusion criteria of our study were relatively general,possibly leading to the lack of pertinence of the results.Some indicators showed apparent heterogeneity among different groups,and more high-quality multi-center studies with large sample sizes are still needed to verify our findings.

关 键 词：糖尿病肾脏病 复方Α-酮酸片 低蛋白饮食 临床疗效 META分析 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]