SGLT2抑制剂联合厄贝沙坦治疗糖尿病肾病疗效的Meta分析

Meta-analysis of Efficacy of SGLT2 Inhibitor Combined with Irbesartan in the Treatment of Diabetic Nephropathy

目的 系统评价钠-葡萄糖协同转运蛋白2(sodium-dependent glucose transporters 2,SGLT2)抑制剂联合厄贝沙坦治疗糖尿病肾病的疗效。方法 检索中国知网、维普、万方、pubmed等数据库,检索时间:各数据库建库至2021年12月,收集SGLT2抑制剂联合厄贝沙坦治疗糖尿病肾病的随机对照试验。设定纳排标准,采用Cochrane偏倚风险评判标准进行文献质量评估,使用RevMan 5.4软件进行Meta分析。结果 共纳入10篇文献,涉及828例糖尿病肾病患者。SGLT2抑制剂联合厄贝沙坦组比单用厄贝沙坦组更能提高糖尿病肾病有效率[RR=1.29,95%CI(1.19,1.40),P<0.000 01],改善24 h尿蛋白定量[SWD=-1.44,95%CI(-2.07,-0.81),P<0.000 01]、尿白蛋白排泄率[SMD=-1.09,95%CI(-1.93,-0.25),P=0.01]、肾小球滤过率[MD=7.83,95%CI(2.51,13.16),P=0.004],血肌酐[MD=-16.87,95%CI(-29.1,-4.65),P=0.007],差异有统计学意义(P<0.05)。结论 SGLT2抑制剂联合厄贝沙坦能提高治疗糖尿病肾病的有效率,减少24 h尿蛋白定量、尿白蛋白排泄率,提高肾小球滤过率,降低血肌酐,期待更多的临床研究进一步验证。

Objective To systematically evaluate the efficacy of sodium-dependent glucose transporters 2( SGLT2) inhibitor combined with irbesartan in the treatment of diabetic nephropathy.Methods CNKI,VIP,Wanfang,pubmed and other databases were searched,search time:each database was established until December 2021.Randomized controlled trials of SGLT2 inhibitors combined with irbesartan in the treatment of diabetic nephropathy were collected.Inclusion criteria were set,Cochrane bias risk assessment criteria were used for literature quality assessment,and Revman 5.4 software was used for meta-analysis.Results A total of 10 articles were included,involving 828 patients with diabetic nephropathy.SGLT2 inhibitor combined with irbesartan could improve the effective rate of diabetic nephropathy compared with irbesartan alone [RR=1.29,95 % CI(1.19,1.40),P<0.000 01].24 h urinary protein quantification [SWD=-1.44,95 % CI(-2.07,-0.81),P<0.000 01],urinary albumin excretion rate [SMD=-1.09,95 % CI(-1.93,-0.25),P = 0.01 ],glomerular filtration rate [MD= 7.83,95 % CI(2.51,13.16),P=0.004],serum creatinine [MD=-16.87,95 % CI(-29.1,-4.65),P=0.007],the difference was statistically significant(P<0.05).Conclusion SGLT2 inhibitor combined with irbesartan can improve the effective rate in the treatment of diabetic nephropathy,reduce 24-hour urinary protein quantitation,urinary albumin excretion rate,improve glomerular filtration rate,and reduce blood creatinine.More clinical studies are expected to further validate.