同型半胱氨酸和C反应蛋白的水平与糖尿病肾病严重程度关联的Meta分析

A Meta-analysis of the Association between Homocysteine/C-reactive Protein Levels and the Severity of Diabetic Nephropathy

目的分析同型半胱氨酸(Hcy)和C反应蛋白(CRP)水平与糖尿病肾病(DN)严重程度间的关联,为预防和治疗DN提供依据。方法系统检索中国知网、万方学术期刊数据库、维普中文科技期刊数据库、Pubmed、Web of science等中英文数据库,收集建库至2022年11月5日有关Hcy和CRP水平与DN严重程度相关联的文献,采用均数差(MD)为效应指标,采用亚组分析探讨异质性来源。结果初期共检索文献386篇,最终纳入8篇。Meta分析结果显示:DN组Hcy和CRP水平高于对照组(Hcy MD=4.47,95%CI:3.88~5.06,P<0.00001;CRP MD=3.23,95%CI:2.34~4.12,P<0.00001);根据24h尿白蛋白排泄率(UAER)截断值的不同进行亚组分析,以30mg/24h和300mg/24h将DN分为3个不同严重程度,显示之间具有差异性统计(Hcy-SDM组MD=1.81,95%CI:0.45~3.18;EDN组MD=4.46,95%CI:1.52~7.39;CDN组MD=7.92,95%CI:3.36~12.47。CRP-SDM组MD=0.87,95%CI:0.54~1.21;EDN组MD=3.03,95%CI:1.80~4.26;CDN组MD=5.57,95%CI:4.55~6.59)。结论Hcy和CRP水平与DN严重程度间具有统计学关联,Hcy和CRP的水平升高程度可提示DN的病程。

Objective To analyze the association between Hcy/CRP levels and the severity of DN,in order to provide evidences for the prevention and treatment of DN.Methods Chinese and English databases such as CNKI,Wanfang Academic journal database,Weipu Chinese science Journal Database,Pubmed and Web of science were systematically searched to collect the literature on the correlation between Hcy/CRP levels and the severity of DN from November 5,2022.Mean difference(MD)was used as the effect index,subgroup analysis was used to explore the source of heterogeneity.Results A total of 386 literature were collected initially,and 8 were eventually adopted.Meta-analysis showed that the levels of Hcy and CRP in DN group were higher than those in control group(Hcy MD=4.58,95%CI:3.98~5.18,P<0.00001;CRP MD=3.35,95%CI:2.38~4.31,P<0.00001);Subgroup analysis was performed according to the different truncation values of 24h urinary albumin excretion rate(UAER).DN was divided into three different severity levels with statistical differences at 30mg/24h and 300mg/24h(Hcy-SDM group MD=1.81,95%CI:0.45~3.18;EDN group MD=4.46,95%CI:1.52~7.39;CDN group MD=7.92,95%CI:3.36~12.47.CRP-SDM group MD=0.87,95%CI:0.54~1.21;EDN group MD=3.03,95%CI:1.80~4.26;CDN group MD=5.57,95%CI:4.55~6.59).Conclusion There is a statistical correlation between the levels of Hcy/CRP and the severity of DN,and the elevated levels of Hcy and CRP indicate the course of DN.