Liu Wei, Yu Jiangyi, Tian Ting, Miao Junjun, Shang Wenbin
Department of Endocrinology and Metabolism, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China.
Department of Endocrinology and Metabolism, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China.
Exp Ther Med. 2019 Jul;18(1):342-351. doi: 10.3892/etm.2019.7577. Epub 2019 May 13.
The efficacy of liraglutide in patients with type 2 diabetes accompanied by early-stage nephropathy has remained to be fully elucidated. The present meta-analysis was performed to determine the clinical outcomes associated with liraglutide treatment. The PubMed, Ovid, Cochrane Library, Chinese National Knowledge Infrastructure and Wanfang databases were searched in October 2018 to identify randomized controlled trials of liraglutide for diabetes patients with early-stage nephropathy. The treatment effect was estimated by calculating the mean difference (MD). Heterogeneity was assessed using χ and I tests. In addition, risk of bias graphs and summaries were used to assess the quality of the trials included. A total of 13 randomized controlled trials were included in the present meta-analysis. In subjects with stage I-II diabetic nephropathy (DN), liraglutide had obvious advantages in lowering the urinary albumin-to-creatinine ratio [UACR; MD=-90.96, 95% confidence interval (CI)=-94.12 to -87.80, P<0.00001], urinary albumin excretion rate (UAER; MD=-64.86, 95% CI=-66.63 to -63.08, P<0.00001), serum creatinine (Scr; MD=-13.67, 95% CI=-17.88 to -9.46, P<0.00001). In subjects with stage-III DN, liraglutide had favorable effects on renal function (UACR: MD=-11.23, 95% CI=-13.14 to -9.32, P<0.00001; UAER: MD=-14.06; 95% CI=-6.93 to -11.18; P<0.00001; Scr: MD=-9.17, 95% CI=-14.61 to -3.72, P=0.0010) and exhibited anti-inflammatory effects (transforming growth factor-β1: P<0.00001; tumor necrosis factor-α: P=0.006; interleukin-6: P<0.00001). Furthermore, liraglutide also reduced the blood lipid levels, body mass index and post-prandial blood glucose. The most common adverse effects of liraglutide were gastrointestinal tract reactions and hypoglycemia, but these symptoms resolved quickly. Liraglutide appears to be effective in reducing proteinuria, improving renal function, producing an anti-inflammatory effect and ameliorating glucose and lipid metabolism in diabetic patients with early-stage nephropathy.
利拉鲁肽在伴有早期肾病的2型糖尿病患者中的疗效仍有待充分阐明。本荟萃分析旨在确定与利拉鲁肽治疗相关的临床结局。于2018年10月检索了PubMed、Ovid、Cochrane图书馆、中国知网和万方数据库，以识别利拉鲁肽用于早期肾病糖尿病患者的随机对照试验。通过计算平均差（MD）来估计治疗效果。使用χ²和I²检验评估异质性。此外，使用偏倚风险图和总结来评估纳入试验的质量。本荟萃分析共纳入13项随机对照试验。在I-II期糖尿病肾病（DN）患者中，利拉鲁肽在降低尿白蛋白与肌酐比值[UACR；MD=-90.96，95%置信区间（CI）=-94.12至-87.80，P<0.00001]、尿白蛋白排泄率（UAER；MD=-64.86，95%CI=-66.63至-63.08，P<0.00001）、血清肌酐（Scr；MD=-13.67，95%CI=-17.88至-9.46，P<0.00001）方面具有明显优势。在III期DN患者中，利拉鲁肽对肾功能有良好影响（UACR：MD=-11.23，95%CI=-13.14至-9.32，P<0.00001；UAER：MD=-14.06；9%CI=-6.93至-11.18；P<0.00001；Scr：MD=-9.17，95%CI=-14.61至-3.72，P=0.0010），并具有抗炎作用（转化生长因子-β1：P<0.00001；肿瘤坏死因子-α：P=0.006；白细胞介素-6：P<0.00001）。此外，利拉鲁肽还降低了血脂水平、体重指数和餐后血糖。利拉鲁肽最常见的不良反应是胃肠道反应和低血糖，但这些症状很快缓解。利拉鲁肽似乎对降低早期肾病糖尿病患者的蛋白尿、改善肾功能、产生抗炎作用以及改善糖脂代谢有效。
