2型糖尿病肾脏疾病躯体危险因素的系统评价

Physical Risk Factors for Type 2 Diabetic Kidney Disease: A Systematic Review

目的系统评价躯体因素与2型糖尿病(T2DM)肾脏疾病的相关性。方法计算机检索MEDLINE、EMbase、CBM、CNKI和VIP数据库,收集所有关于T2DM肾脏疾病躯体危险因素的研究,检索时限截至2012年12月。由2名研究者按照纳入与排除标准筛选文献,提取数据和评价纳入研究的方法学质量后,采用RevMan5.2软件进行Meta分析。结果共纳入11个研究,12957例T2DM患者。其中9个研究为横断面研究,1个为病例-对照研究,1个为队列研究。研究结果显示:与T2DM肾脏疾病相关的躯体因素主要有糖尿病病程[OR=1.11,95%CI(1.05,1.18)]、腰围[OR=1.02,95%CI(1.00,1.04)]、空腹血糖[OR=1.11,95%CI(1.07,1.16)]、糖化血红蛋白[OR=1.20,95%CI(1.06,1.36)]、收缩压[OR=1.03,95%CI(1.02,1.05)]、舒张压[OR=2.41,95%CI(1.15,4.64)]、甘油三酯[OR=1.24,95%CI(1.02,1.51)]、高密度脂蛋白[OR=0.558,95%CI(0.369,0.844)]、血尿酸[OR=1.005,95%CI(1.002,1.009)]、血尿素氮水平[OR=1.58,95%CI(1.37,1.82)]、肾脏疾病史[OR=3.26,95%CI(1.20,8.87)]及肾脏疾病家族史[OR=1.83,95%CI(1.29,2.60)]。结论现有证据表明,与T2DM并发肾脏疾病相关的躯体因素众多。受纳入研究数量和质量所限,本研究结论尚需更多高质量研究进一步验证。

Objective To systematically review the independent physical risk factors associated with diabetic kid- ney disease （DKD） in patients with type 2 diabetes mellitus. Methods We searched MEDLINE, EMbase, CBM, CNKI and VIP for all studies about the independent physical risk factors associated with diabetic kidney disease （DKD） in pa- tients with type 2 diabetes mellitus up to December 2012. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta- analysis was conducted using RevMan 5.2 software. Results A total of 11 studies involving 12 957 patients with type 2 diabetes were included. Of these 11 studies, 9 were cross-sectional studies, two were cohort studies, and one was case- control study. The results showed that： the main physical factors associated with DKD were： duration of diabetes （OR= 1.11, 95%CI 1.05 to 1.18）, waist circumference （OR=1.02, 95%CI 1.00 to 1.04）, fasting glucose （OR=1.11, 95%CI 1.07 to 1.16）, glycosylated hemoglobin （OR=1.20, 95%CI 1.06 to 1.36）, systolic blood pressure （OR=1.03, 95%CI 1.02 to 1.05）, diastolic blood pressure （OR=2.41, 95%CI 1.15 to 4.64）, triglycerides （OR=1.24, 95%CI 1.02 to 1.51）, high-density lipoprotein （OR=0.558, 95%CI 0.369 to 0.844）, blood uric acid （OR=1.005, 95%CI 1.002 to 1.009）, blood urea nitrogen （OR=1.58, 95%CI 1.37 to 1.82）, past history of kidney disease （OR=3.26, 95%CI 1.20 to 8.87） and family history of kidney disease （OR=1.83, 95%CI 1.29 to 2.60）. Conclusion Current evidence shows that multiple physical factors were associated with the development of type 2 diabetic kidney disease. However, due to the limited quantity and quality of the included stud- ies, more high quality studies are needed to verify the conclusion.