新型抗糖尿病药物对 2 型糖尿病患者蛋白尿的影响：一项随机对照试验的系统评价和荟萃分析。
The Effects of Novel Antidiabetic Drugs on Albuminuria in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
机构信息
Department of Cardiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China.
Department of Endocrinology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China.
出版信息
Clin Drug Investig. 2018 Dec;38(12):1089-1108. doi: 10.1007/s40261-018-0707-4.
BACKGROUND AND OBJECTIVE
The effects of novel antidiabetic drugs, including sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors, on albuminuria in patients with type 2 diabetes mellitus (T2DM) are still controversial. Therefore, we performed a meta-analysis to evaluate the effects of novel antidiabetic drugs on albuminuria in patients with T2DM.
METHODS
We conducted a random-effects meta-analysis of randomized controlled trials (RCTs) by searching the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases up to 16 August 2018. The effects of novel antidiabetic drugs on albuminuria were evaluated as percent changes from baseline to follow-up urinary albumin excretion/urinary albumin to creatinine ratio (UAE/UACR) levels in both the intervention and control groups. Data regarding percent changes were used to generate weighted mean differences (WMDs) and 95% confidence intervals (CIs).
RESULTS
In this meta-analysis, 26 RCTs involving 14,929 patients were included. Pooled analysis suggested that SGLT-2 inhibitors (WMD - 26.23%, 95% CI - 35.90 to - 16.56; p < 0.00001) and GLP-1 receptor agonists (WMD - 13.85%, 95% CI - 15.96 to - 11.74; p < 0.00001) were associated with a significant reduction in albuminuria compared with other conventional therapies or placebo. DPP-4 inhibitors (WMD - 6.19%, 95% CI - 14.03 to 1.66; p = 0.12) were not significantly associated with lower albuminuria than other conventional therapies or placebo.
CONCLUSION
This meta-analysis indicates that SGLT-2 inhibitors and GLP-1 receptor agonists were associated with a reduction in albuminuria compared with other conventional therapies or placebo, while DPP-4 inhibitors were not associated with albuminuria-reducing effects compared with other conventional therapies or placebo.
背景和目的
新型抗糖尿病药物，包括钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂、胰高血糖素样肽 1（GLP-1）受体激动剂和二肽基肽酶 4（DPP-4）抑制剂，对 2 型糖尿病（T2DM）患者的蛋白尿的影响仍存在争议。因此，我们进行了一项荟萃分析，以评估新型抗糖尿病药物对 T2DM 患者蛋白尿的影响。
方法
我们通过检索 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册数据库，截至 2018 年 8 月 16 日，对随机对照试验（RCT）进行了随机效应荟萃分析。通过比较干预组和对照组的基线至随访尿白蛋白排泄/尿白蛋白与肌酐比值（UAE/UACR）水平的百分比变化来评估新型抗糖尿病药物对蛋白尿的影响。采用均数差值（WMD）及其 95%置信区间（CI）表示数据的变化情况。
结果
本荟萃分析共纳入 26 项 RCT，涉及 14929 例患者。汇总分析表明，SGLT-2 抑制剂（WMD-26.23%，95%CI-35.90 至-16.56；p<0.00001）和 GLP-1 受体激动剂（WMD-13.85%，95%CI-15.96 至-11.74；p<0.00001）与其他常规治疗或安慰剂相比，可显著降低蛋白尿。与其他常规治疗或安慰剂相比，DPP-4 抑制剂（WMD-6.19%，95%CI-14.03 至 1.66；p=0.12）与降低蛋白尿无显著相关性。
结论
本荟萃分析表明，与其他常规治疗或安慰剂相比，SGLT-2 抑制剂和 GLP-1 受体激动剂可降低蛋白尿，而 DPP-4 抑制剂与降低蛋白尿的效果与其他常规治疗或安慰剂相比无相关性。
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