糖尿病病人并发肾病危险因素的Meta分析

Meta-analysis of risk factors for kidney disease in diabetic patients

目的:通过Meta分析明确糖尿病病人发生肾病的危险因素。方法:计算机检索PubMed、Web of Science、the Cochrane Library、EBSCO、SpringerLink、BMJ Journals、中国知网、万方数据库、维普和中国生物医学文献数据库中关于糖尿病病人并发肾病危险因素的研究,检索时间为建库至2019年7月,采用RevMan 5.3软件和Stata 15.1软件进行Meta分析。结果:共纳入24项研究,涉及459375例病人。糖尿病肾病的危险因素包括年龄[SMD=0.41,95%CI(0.13,0.69),P=0.004]、吸烟[OR=1.46,95%CI(1.34,1.60),P<0.00001]、糖尿病病程[SMD=3.33,95%CI(2.37,4.29),P<0.00001]、收缩压[SMD=9.54,95%CI(6.49,12.59),P<0.00001]、糖化血红蛋白[SMD=0.66,95%CI(0.45,0.86),P<0.00001]、视网膜病变[OR=5.15,95%CI(4.86,5.45),P<0.00001]、三酰甘油[SMD=0.32,95%CI(0.21,0.43),P<0.00001]、高密度脂蛋白[SMD=-0.10,95%CI(-0.11,-0.09),P<0.00001]。结论:现有证据表明,年龄、吸烟、糖尿病病程、收缩压、糖化血红蛋白、视网膜病变、三酰甘油、高密度脂蛋白是糖尿病病人发生肾病的危险因素,体质指数对罹患糖尿病肾病的影响不确定。本研究结果可为临床医护人员早期识别糖尿病肾病高危人群提供参考依据。

Objective:To identify the risk factors of diabetic kidney disease in patients with diabetes mellitus by Meta-analysis.Methods:Studies on risk factors of diabetic kidney disease among diabetes patients were searched from PubMed,Web of Science,the Cochrane Library,EBSCO,SpringerLink,BMJ Journals,CNKI,WanFang database,VIP and CBM.The retrieval time was from inception to July 2019.RevMan 5.3 and Stata 15.1 softwares were used for Meta-analysis.Results:A total of 24 studies were included,involving 459375 patients.Risk factors for diabetic kidney disease include:age[SMD=0.41,95%CI(0.13,0.69),P=0.004],smoking[OR=1.46,95%CI(1.34,1.60),P<0.00001],diabetes duration[SMD=3.33,95%CI(2.37,4.29),P<0.00001],systolic blood pressure[SMD=9.54,95%CI(6.49,12.59),P<0.00001],glycosylated hemoglobin[SMD=0.66,95%CI(0.45,0.86),P<0.00001],retinopathy[OR=5.15,95%CI(4.86,5.45),P<0.00001],triglyceride[SMD=0.32,95%CI(0.21,0.43),P<0.00001],high density lipoprotein[SMD=-0.10,95%CI(-0.11,-0.09),P<0.00001].Conclusion:Current evidences shows that age,smoking,duration of diabetes,systolic blood pressure,glycosylated hemoglobin,retinopathy,triglycerides and high density lipoprotein are the risk factors for DKD in diabetic patients.The influence of BMI on diabetic kidney disease is uncertain.The results of this study can provide reference for early identification of high-risk groups of diabetic kidney disease.