活性维生素D3对2型糖尿病患者肾脏保护作用的Meta分析

Renal protective role of active vitamin D3 supplement in oatients with type 2 diabetes:a meta-analysis

目的系统评价活性维生素D3治疗2型糖尿病（type 2 diabetes，T2DM）的有效性和安全性以及其对肾脏的保护作用。方法计算机检索PubMed、EMBase、谷歌学术、中国知网、维普数据库、万方数据库和中国生物医学文献数据库，检索时间范围均从建库至2014年12月。收集以活性维生素D3为干预措施治疗T2DM的临床随机对照试验（randomized controlled trials，RCT），按照Coehrane系统评价方法，对纳入标准的RCT进行方法学质量评价和疗效指标合并分析。结果共纳入10个RCT。采用固定效应模型对尿白蛋白肌酐比值（urinary albumin creatinine ratio，UACR）进行比较，加权均数差（standardized mean difference，SMD）=-0．34（95％CI：-0．55，-0．12；P=0．002），治疗组较对照组明显降低；采用随机效应模型对血肌酐进行比较：SMD=-1．27（95％ CI：-3．66，1．12；P=0．30），差异无统计学意义（P〉0．05）；另外，治疗组在降低T2DM患者胰岛素抵抗、三酰甘油、总胆固醇、收缩压和升高高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）等方面效果与对照组比较[SMD或加权均数差（weighted mean difference，WMD）（95％CI）分别为-2．69（-3．42，-1．97）；-0．37（-0．63，-0．11）；-0．30（-0．56，-0．05）；-5．94（-9．08，-2．80）；0．33（0．03，0．63）]，差异有统计学意义（P〈0．05）；但对糖化血红蛋白（glycosylated hemoglobin，HbAle）和舒张压无明显影响[WMD）（95％CI）分别为0．06（-0．08，0．19），-1．77（-3．65，-0．12）；P〉0．05]。结论活性维生素D3可以改善T2DM患者糖代谢，降低血脂、血压及蛋白尿，具有一定的肾脏保护作用。

Objective To systematically evaluate the efficacy, safety and the renoprotective effect of active vitamin D3 treatment in patients with type 2 diabetes mellitus （T2DM）. Methods Literature searches were performed with PubMed, EMBase, Google scholar, CNKI, VIP, Wanfang Date and CBM from inception to December 2014. Publications of the randomized controlled trials on the treatment of T2DM with active vitamin D3 were included. The methodology quality of the included studies was assessed and the pooled analysis on therapeutic effect index was performed by two review- ers independently according to the criteria of the Cochrane handbook. Results A total of 10 eligible RCT were included. The fixed-effect model was used to analyze urinary albumin ereatinine ratio （UACR）, and the pooled SMD was - 0. 34 （95 % CI.. - 0. 55, - 0. 12）, P = 0. 002, which indicated that active vitamin D3-treated group had a statistically significant reduction in UACR. The randomeffect model was used to analyze serum creatinine, and the pooled SMD was -1.27 （95% CI： - 3. 66, 1.12）, P = 0. 30, which indicated that there was no statistically significant difference between experimental group and control group. In addition, active vitamin D3-treated group was more obvious than control group in terms of lowering insulin resistance, serum cholesterol, triglycerides, systolic pressure, and increasing high-density lipoprotein cholesterol （HDL-C） in patients with T2DM （P〈0.05）[SMI）orWMD（95% CI） was -2.69 （-3.42, -1.97）; -0.37 （-0.63, -0.11）, -0.30 （ - 0. 56, - 0. 05） ; - 5. 94 （ - 9. 08, - 2. 80） ; 0. 33 （0. 03, 0. 63）, respectively]. However, there was no statistically significant difference in hemoglobin Alc （HbA1c） and diastolic pressure between experimental group and control group （P 〉 0. 05 ） [ WMD （ 95 % CI） was 0. 06 （ - 0. 08, 0. 19 ） - 1.77 （ - 3.65, - 0. 12）, respectively]. Conclusions Currently available evidence shows that active vitamin D3 is effective in improving glucose metabolism, and reducing blood lipids and blood pressure in T2DM patients. It can also reduce proteinuria, and protect renal function to some extent.