抗炎类药物治疗糖尿病肾病的Meta分析
Anti-inflammatory drugs in the treatment of diabetic nephropathy:a Meta-analysis
赵阳 1韦青清 1战翔宇 1张冬瑞 1刘佳 1薛嵩 1张杨 1邓佳豪 1隋洪玉1
作者信息
- 1. 佳木斯大学基础医学院生理学教研室(黑龙江佳木斯 154007);黑龙江省微生物-免疫调解网络与相关疾病重点实验室(黑龙江佳木斯 154007)
- 折叠
摘要
目的 系统评价抗炎类药物治疗糖尿病肾病(DN)的有效性.方法 采用 PubMed、The Cochrane Library、Embase、Web of Science、Scopus、Ovid、ProQuest、CBM、CNKI、万方、VIP、读秀数据库,搜集抗炎类药物治疗DN的随机对照试验(RCT),检索时限从建库至2022年4月5日.由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析.结果 共纳入29篇文献,含26个RCT,4 095例患者.Meta分析结果显示,与常规治疗相比,常规治疗联合抗炎类药物治疗DN能够有效降低尿白蛋白与肌酐比值[SMD=-0.17,95％CI(-0.31,-0.03),P=0.02]、尿白蛋白排泄率[SMD=-0.37,95％CI(-0.56,-0.18),P=0.000 1]、尿蛋白排泄率[SMD=-0.97,95％CI(-1.29,-0.64),P＜0.00001]和糖化血红蛋白[SMD=-0.17,95％CI(-0.27,-0.08),P=0.000 4];而在降低血肌酐[SMD=-0.04,95％CI(-0.19,0.1),P=0.57]、尿素氮[MD=-0.23,95％CI(-0.50,0.04),P=0.09]和空腹血糖[SMD=-0.15,95％CI(-0.32,0.02),P=0.08]方面差异无统计学意义;除少数药物外,多种药物在改变肾小球滤过率[SMD=-0.04,95％CI(-0.15,0.07),P=0.47]方面差异无统计学意义.结论 常规治疗联合抗炎类药物,能更好地改善DN患者的蛋白尿水平,但肾功能改善不明显.受纳入研究数量及疗程限制,上述结论有待更多高质量研究验证.
Abstract
Objective To systematically review the efficacy of anti-inflammatory drugs in the treatment of diabetic nephropathy(DN).Methods Databases including PubMed,The Cochrane Library,EMbase,Web of Science,Scopus,Ovid,ProQuest,CBM,CNKI,WanFang Data,VIP and Duxiu data were electronically searched to collect randomized controlled trials(RCTs)of anti-inflammatory drugs for DN from inception to April 5,2022.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias of the included studies.RevMan 5.4 software were then used to perform Meta-analysis.Results A total of 29 literature and 26 RCTs involving 4 095 patients were included.The results of Meta-analysis showed that compared with conventional treatment,conventional treatment combined with anti-inflammatory drugs could effectively reduce urinary albumin to creatinine ratio[SMD=-0.17,95％CI(-0.31,-0.03),P=0.02],urinary albumin excretion rate[SMD=-0.37,95％CI(-0.56,-0.18),P=0.000 1],urinary protein excretion rate[SMD=-0.97,95％CI(-1.29,-0.64),P=0.000 01],and glycosylated hemoglobin[SMD=-0.17,95％CI(-0.27,-0.08),P=0.000 4],while there was no significant difference in reducing serum creatinine[SMD=-0.04,95％CI(-0.19,0.1),P=0.57],urea nitrogen[MD=-0.23,95％CI(-0.50,0.04),P=0.09]and fasting blood glucose[SMD=-0.15,95％CI(-0.32,0.02),P=0.08].There was no statistically significant difference in changing glomerular filtration rate(GFR)[SMD=-0.04,95％CI(-0.15,0.07),P=0.47]with multiple drugs,except for a few drugs.Conclusion Conventional treatment combined with anti-inflammatory drugs can better improve the level of proteinuria in patients with DN,but the improvement of renal function is not obvious.Due to the limitations of the number of included studies and the duration of treatment,the above conclusion needs to be verified by more high-quality studies.
关键词
抗炎药/糖尿病肾病/炎症/系统评价/Meta分析/肾小球滤过率/血清肌酐/尿毒氮Key words
Anti-inflammatory drugs/Diabetic nephropathies/Inflammation/Systematic review/Meta-analysis/Glomerular filtration rate/Serum creatinine/Urea nitrogen引用本文复制引用
基金项目
佳木斯大学基础研究类(自然类)国家自然科学基金培育项目(JMSUGPZR2022-012)
出版年
2024
NETL
NSTL
万方数据