血清尿调蛋白与糖尿病肾病的关系：系统评价和荟萃分析。

Association of serum uromodulin with diabetic kidney disease: a systematic review and meta-analysis.

机构信息

Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt.

Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

出版信息

BMC Nephrol. 2024 Nov 24;25(1):421. doi: 10.1186/s12882-024-03854-x.

DOI:10.1186/s12882-024-03854-x

PMID:39581971

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11587581/

Abstract

BACKGROUND

Several studies have investigated the association between the changes of serum uromodulin and diabetic kidney disease (DKD). However, the results are still controversial. Therefore, this meta-analysis was conducted to provide a comprehensive evaluation of the association between serum uromodulin levels and DKD.

METHODS

PubMed, Cochrane library, Web of Science, and Scopus were systemically searched following the PRISMA protocol to identify the studies that reported the relationship between serum uromodulin level and DKD. To investigate the association between uromodulin and DKD, a standardized mean difference (SMD) with a 95% confidence interval (CI) was used. When significant heterogeneity was detected (I > 50%), sensitivity and subgroup analyses were performed to determine the source of heterogeneity. The quality assessment was determined using the Newcastle-Ottawa scale (NOS), and the publications bias were determined by the funnel plot and Egger's test.

RESULTS

In total, 6 studies with 1774 patients were included in the final analysis. The random effect model was used. The pooled results showed that the serum uromodulin levels were significantly decreased in patients with DKD (SMD: -0.31; 95% CI: -0.48 to -0.13) (I = 45%). Upon applying the sensitivity analysis, it showed (SMD: -0.38; 95% CI: -0.49 to -0.27) (I = 3%). Subgroup analysis showed that uromodulin level was significantly decreased in DKD regardless of the region of study, in America (SMD: -0.34; 95% CI: -0.51 to -0.17; p < 0.0001), Europe (SMD: -0.54; 95% CI: -1.06 to -0.02; p = 0.04), and Asia (SMD: -0.63; 95% CI: -1.15 to -0.11; p = 0.02), with stronger predictive value in America and Asia than in Europe. Additionally, uromodulin levels were significantly decreased in both type 1 (SMD: -0.34; 95% CI: -0.51 to -0.17; p < 0.0001) and type 2 diabetes (SMD: -0.58; 95% CI: -0.95 to -0.22; p = 0.002).

CONCLUSION

This meta-analysis showed a significant association between low levels of serum uromodulin and DKD. So, it could have a predictive role for DKD. However, its performance varied across subgroup analyses restricted by race and clinical settings. Moreover, further studies are required with a focus on the cut-off value for predicting diagnostic accuracy.

摘要

背景

已有多项研究探讨了血清尿调蛋白水平变化与糖尿病肾病（DKD）之间的关联。然而，结果仍存在争议。因此，本荟萃分析旨在对血清尿调蛋白水平与 DKD 之间的关联进行综合评估。

方法

按照 PRISMA 协议系统检索 PubMed、Cochrane 图书馆、Web of Science 和 Scopus 数据库，以确定报告血清尿调蛋白水平与 DKD 之间关系的研究。为了研究尿调蛋白与 DKD 之间的关系，使用标准化均数差（SMD）及其 95%置信区间（CI）。当检测到显著的异质性（I>50%）时，进行敏感性分析和亚组分析以确定异质性的来源。使用纽卡斯尔-渥太华量表（NOS）进行质量评估，使用漏斗图和 Egger 检验评估发表偏倚。

结果

最终分析共纳入 6 项研究，共计 1774 例患者。采用随机效应模型。汇总结果显示，DKD 患者的血清尿调蛋白水平显著降低（SMD：-0.31；95%CI：-0.48 至-0.13）（I=45%）。通过敏感性分析，结果显示（SMD：-0.38；95%CI：-0.49 至-0.27）（I=3%）。亚组分析显示，无论研究地区是在美国（SMD：-0.34；95%CI：-0.51 至-0.17；p<0.0001）、欧洲（SMD：-0.54；95%CI：-1.06 至-0.02；p=0.04）还是亚洲（SMD：-0.63；95%CI：-1.15 至-0.11；p=0.02），尿调蛋白水平均显著降低，且美国和亚洲的预测价值强于欧洲。此外，尿调蛋白水平在 1 型糖尿病（SMD：-0.34；95%CI：-0.51 至-0.17；p<0.0001）和 2 型糖尿病（SMD：-0.58；95%CI：-0.95 至-0.22；p=0.002）患者中均显著降低。