钠-葡萄糖共转运蛋白-2抑制剂对2型糖尿病患者肾脏结局的系统评价和Meta分析

A systematic review and Meta-analysis of sodium-glucose cotransporter-2 inhibitors(SGLT-2I)on renal outcomes in type 2 diabetic patients

目的:通过系统评价探讨糖尿病患者使用钠-葡萄糖共转运蛋白-2抑制剂(SGLT-2I)对肾脏的影响,为临床用药提供循证依据。方法:系统检索中国知网、万方、维普、中国生物医学文献数据库、Medline(Ovid)、EMBASE(Ovid)以及CENTRAL数据库,检索时间为建库至2022年11月9日,纳入被明确诊断为2型糖尿病的患者,并对符合标准的随机对照试验进行质量评估和数据提取,并使用Stata16 MP对数据进行分析。结果:研究共纳入文献12篇,包含8个随机对照试验以及4个预先设定的包含肾脏结局的亚组分析研究,涉及60767例患者,系统评价结果显示与安慰剂组相比,接受SGLT-2I治疗显著改善了糖尿病患者肾脏恶化、终末期肾脏疾病或肾脏死亡的复合肾脏结局的发生风险[RR=0.63,95%CI(0.57~0.69)],而且这种获益在慢性肾疾病患者中也依然存在。结论:SGLT-2I对糖尿病患者具有显著的肾脏保护作用。

OBJECTIVE To investigate the effect of sodium glucose cotransporter 2 inhibitor on kidney in patients with dia⁃betes through systematic review,and to provide evidence for clinical medication.METHODS CNKI,Wanfang,VIP,China Biomedical Literature Database,Ovid Medline,Ovid EMBASE and CENTRAL database were searched systematically from inception to November 9,2022.Patients with a definite diagnosis of type 2 diabetes were included and eligible randomized con⁃trolled trials were evaluated for quality and data extraction.Data were analyzed using Stata16 MP.RESULTS A total of 12 stud⁃ies were included,including 8 randomized controlled trials and 4 pre-determined subgroup studies with renal outcomes,involving 60767 patients.The systematic review showed that treatment with SGLT-2I significantly improved the risk of complex renal out⁃comes from renal deterioration,end-stage renal disease,or renal death in patients with diabetes compared with placebo RR0.63,95%CI(0.57-0.69),and this benefit persisted in patients with chronic renal disease.CONCLUSION SGLT-2I has sig⁃nificant renal protection effect in diabetic patients.