胰高血糖素样肽-1受体激动剂治疗糖尿病肾脏疾病疗效的Meta分析  

Meta-analysis of the efficacy of glucagon-like peptide-1 receptor agonists in the treatment of diabetic nephropathy

作　　者：廖泽锦 陈金虎 倪利华 吴小燕[1] Liao Ze-jin;Chen Jin-hu;Ni Li-hua;Wu Xiao-yan(Department of Nephrology,Zhongnan Hospital,Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院肾内科,武汉430071

出　　处：《临床肾脏病杂志》2024年第12期983-992,共10页Journal Of Clinical Nephrology

摘　　要：目的对胰高血糖素样肽-1受体激动剂(glucagon-like peptide-1 receptor agonists,Glp-1 ras)治疗糖尿病肾脏疾病(diabetic kidney disease,DKD)的疗效进行系统评价。方法检索Pub Med、EMbase和Cochrane Library等外文数据库、万方数据、中国知网、中国生物医学文献服务系统、维普期刊资源整合服务平台等中文数据库。根据Cochrane手册的质量评估标准对纳入研究进行质量评估,并使用Rev Man5.3软件对数据进行分析。结果通过文献筛选最终纳入13篇随机对照试验,共涉及了1136例DKD患者,最终整合结果显示,治疗组Glp-1 ras与对照组相比,显著改善了24 h尿蛋白定量[MD=-13.44,95%CI(-17.09,-9.79),I2=5%,P<0.00001]、尿白蛋白/肌酐比值[MD=-15.27,95%CI(-17.12,-13.42),I2=88%,P<0.00001]、尿素氮[MD=-1.21,95%CI(-1.41,-1.00),I2=27%,P<0.00001]、糖化血红蛋白[SMD=-1.12,95%CI(-1.31,-0.94),I2=38%,P<0.00001]、血肌酐[MD=-7.55,95%CI(-9.92,-5.17),I2=19%,P<0.00001]、血清总胆固醇[MD=-0.56,95%CI(-0.70,-0.42),I2=30%,P<0.00001]以及体重指数[MD=-3.61,95%CI(-4.47,-2.76),I2=0%,P<0.00001],差异具有统计学意义。结论Glp-1 ras在DKD的治疗中具有良好疗效,对改变肾脏结局、改善代谢水平有明显的作用,不过仍需要更高的质量证据加以验证。Objective To systematically evaluate the efficacy of glucagon-like peptide-1 recep-tor agonists(Glp-1 ras)in the treatment of Diabetic Kidney Disease(DKD).Methods Foreign language databases such as Pub Med,EMbase and Cochrane Library,and Chinese databases such as Wanfang data,China National Knowledge Infrastructure Project,Chinese biomedical literature service system and VIP pe-riodical resource integration service platform were searched.The quality of the included studies was as-sessed according to the quality assessment criteria of the Cochrane handbook,and the data were analyzed by Rev Man 5.3 software.Results Thirteen randomized controlled trials involving 1136 DKD patients were finally included.The results showed that the glucagon-like peptide-1 receptor agonist treatment group significantly improved 24-h urinary protein[MD=-13.44,95%CI(-17.09,-9.79),I2=5%,P<0.00001],urinary albumin/creatinine ratio[MD=-15.27,95%CI(-17.12,-13.42),I2=88%,P<0.00001],blood-urea-nitrogen[MD=-1.21,95%CI(-1.41,-1.00),I2=27%,P<0.00001],glycosylated hemoglobin[SMD=-1.12,95%CI(-1.31,-0.94),I2=38%,P<0.00001],Serum creatinine[MD=-7.55,95%CI(-9.92,-5.17),I2=19%,P<0.00001],total serum cholesterol[MD=-0.56,95%CI(-0.70,-0.42),I2=30%,P<0.00001],and body mass index[MD=-3.61,95%CI(-4.47,-2.76),I2=0%,P<0.00001],the differences were statisti-cally significant.Conclusion Glucagon-like peptide-1 receptor agonists have good efficacy in the treat-ment of diabetic nephropathy,with a significant effect on changing renal outcomes and improving metabol-ic levels,although higher quality evidence is needed for validation.

关 键 词：胰高血糖素样肽-1受体激动剂 糖尿病肾脏疾病 META分析 

分 类 号：R692.9[医药卫生—泌尿科学] R587.2[医药卫生—外科学]