达格列净对早期糖尿病肾病患者肾脏保护作用的Meta分析

Meta analysis of the protective effect of dapagliflozin on early diabetic nephropathy

目的 采用Meta分析探究达格列净对早期糖尿病肾病患者肾脏的保护作用,为临床提供参考。方法 检索中国知网、万方数据库、维普数据库、中国生物医学数据库等中文数据库,以及Pubmed、Embase、Cochrane等英文数据库。检索时间为建库至2023年6月,检索内容为达格列净对早期糖尿病肾病患者肾脏保护作用的随机对照试验,筛选文献、提取数据并评价研究质量,根据不同的干预措施分为观察组和对照组,使用RevMan 5.4进行Meta分析。结果 共纳入22项研究,涉及1 975例患者。Meta分析显示,观察组尿白蛋白/肌酐比值差值(P <0.000 01)、尿微量白蛋白差值(P <0.000 01)、血尿酸差值(P=0.002)、人巨噬细胞趋化蛋白-1差值(P <0.000 01)、白细胞介素-6差值(P=0.000 02)和转化生长因子α差值(P <0.000 01)均高于对照组。但2组的尿白蛋白排泄率差值、24 h尿蛋白定量差值、肾小球滤过率差值、血肌酐差值和血尿素氮差值比较差异均无统计学意义(P> 0.05)。结论 达格列净对早期糖尿病肾病患者具有一定的肾脏保护作用,但仍需设计严谨的大规模临床随机对照试验进行验证。

AIM To explore the renal protection effect of dapagliflozin on early diabetic nephropathy patients,so as to provide reference for clinical practice.METHODS Chinese databases such as CNKI,Wanfang data,VIP,CBM,and English databases such as Pubmed,Embase,Cochrane were searched.The search period was from the establishment of the database to June 2023.Randomized controlled studies of dapagliflozin on renal protection in patients with early diabetic nephropathy were queried.Literature screening,data extraction and study quality evaluation were conducted.Patients were divided into obvervation group and control group,and Meta-analysis was performed using RevMan 5.4.RESULTS A total of 1975 patients were included in 22 studies.Meta-analysis showed that compared with the control group,the difference in urine albumin-creatine ratio(P<0.0001),the difference in microalbunminuria(P<0.0001),the difference in serum uric acid(ΔUA,P=0.002),the difference in human macrophage chemoattractant protein-1(P<0.00001),the difference in interleukin-6(P=0.00002),and the difference in transforming growth factor-alpha(P<0.00001)in the observation group were all higher than those in the control group.However,differences in urinary albumin excretion rate,24 h-uridine triphosphate,glomerular filtration rate,serum creatinine,and blood urea nitrogen between 2 groups were not statistically significant(P>0.05).CONCLUSION Dapagliflozin has shown a certain protective effect on early diabetic nephropathy.However,given the limitations of the inclusion study,it still needs to be verified by large-scale randomized controlled clinical studies with rigorous design.