利拉鲁肽对2型糖尿病患者肾功能以及尿蛋白影响的Meta分析

doi:10.3969/j.issn.1006-7795.2025.05.016

摘要/Abstract

摘要： 目的本研究旨在探究利拉鲁肽对2型糖尿病（type 2 diabetes mellitus，T2DM）患者估算肾小球滤过率（estimated glomerular filtration rate，eGFR）和尿白蛋白肌酐比（urine albumin-to-creatinine ratio，UACR）的影响。方法采用计算机系统检索美国国立医学图书馆（PubMed）、医学文摘数据库（Embase）、Cochrane循证医学数据库（Cochrane Library）、万方数据库和中国知网数据库（China National Knowledge Infrastructure, CNKI），根据纳入标准，收集建库至2024年 6月30日期间发表的利拉鲁肽治疗2型糖尿病（type 2 diabetes mellitus, T2DM）患者的随机对照试验（randomized controlled trials，RCTs），计算治疗前后的eGFR和UACR改变的效应值，采用固定效应或随机效应模型进行数据拟合，依据I²指数定量评价异质性。基于Cochrane标准，对符合条件的临床研究进行质量评级。使用标准方法进行敏感性分析，采用Begg与Egger检验评价发表偏倚。采用Revman 5.3与Stata 12.0软件进行数据分析。结果系统检索后，最终纳入10篇文献，包括11项RCTs（合计657例患者），其中322例患者接受利拉鲁肽降糖治疗。纳入研究的总体质量评级为中等。与对照组相比，利拉鲁肽治疗组的患者eGFR未发生明显改变(WMD=4.52 mL/min/1.73 m²，95% CI: -2.79~ 11.84，I²=88%，P =0.23)，而UACR明显降低(WMD=-13.48 mg/g，95% CI: -22.68 ~ -4.29，I² =75%，P =0.004）。敏感性分析证实Meta分析结果较为可靠，Begg与Egger检验结果未见发表偏倚。结论利拉鲁肽的应用不影响T2DM患者的eGFR水平，但可降低UACR水平，起到一定程度的肾保护作用。

关键词: 利拉鲁肽, 2型糖尿病, 估算肾小球滤过率, 尿白蛋白肌酐比, 胰高血糖素样肽-1受体激动剂, Meta分析

Abstract: Objective This study aimed to explore the effect of liraglutide on estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) levels in patients with type 2 diabetes mellitus (T2DM). Methods Databases including PubMed, Embase, Cochrane Library, WanFang, and China National Knowledge Infrastructure (CNKI) were systematically searched from inception to June 30, 2024. According to the inclusion criteria, randomized controlled trials (RCTs) involving intervention of liraglutide in T2DM were identified. Parameters of eGFR and UACR were extracted pre- and post-treatment in each study. A fixed or random-effects model was used for quantitative synthesis according to the heterogeneity, which was assessed with I² index. Quality of eligible RCTs was evaluated based on the Cochrane criteria. Sensitivity test was conducted by using the standard method. Publication bias was evaluated according the Begg’s and Egger’s tests. Meta-analysis was performed with Revman 5.3 and Stata 12.0 softwares. Results A total of 10 studies, which included 11 RCTs and involved 657 patients, were ultimately identified after performing a systematic search. Of these, 322 patients were administered with liraglutide. The overall quality of eligible RCTs was rated as medium. Compared with control group, no significant changes of eGFR (WMD=4.52 mL/min/1.73 m²，95% CI: -2.79-11.84，I²=88%，P =0.23) was observed in liraglutide-treated participants. In contrast, liraglutide significantly improved levels of UACR (WMD=-13.48 mg/g，95% CI: -22.68 - -4.29，I² =75%，P =0.004）. The results were stable according to the sensitivity test. No significant publication bias was demonstrated after performing the Begg’s and Egger’s tests. Conclusions The administration of liraglutide prevented the decline of eGFR and reduced UACR in T2DM. These results suggested that diabetic participants potentially benefit more from liraglutide treatment in clinical practice.

Key words: liraglutide, type 2 diabetes mellitus, estimated glomerular filtration rate, urine albumin-to-creatinine ratio, glucagon-like peptide-1 receptor agonists, Meta-analysis

中图分类号:

R587.1 R587.2

封怡多, 周亦伦. 利拉鲁肽对2型糖尿病患者肾功能以及尿蛋白影响的Meta分析[J]. 首都医科大学学报, 2025, 46(5): 866-876.

Feng Yiduo, Zhou Yilun. Effect of liraglutide on renal function and proteinuria level in patients with type 2 diabetes mellitus: a Meta-analysis[J]. Journal of Capital Medical University, 2025, 46(5): 866-876.

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