二肽基肽酶 IV 抑制剂对糖尿病肾病患者的安全性和有效性：系统回顾与元分析

IF 1.6 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Current Therapeutic Research-clinical and Experimental Pub Date : 2024-01-01 DOI:10.1016/j.curtheres.2024.100763

Adili Tuersun M.A. , Munire Mohetaer M.A. , Guanxin Hou B.A. , Gang Cheng Ph.D

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引用次数: 0

摘要

背景研究二肽基肽酶-4（DPP-4）抑制剂在糖尿病肾病患者中的安全性和有效性。方法我们在多个数据库中进行了全面的文献检索，包括Embase、PubMed、CNKI和Cochrane对照试验中央注册中心（Cochrane Central Register of Controlled Trials），检索时间从开始到2024年1月。检索的重点是直接比较 DPP-4 抑制剂与安慰剂或其他降糖疗法的随机对照试验 (RCT)。结果纳入了 23 项随机对照试验，共有 16,378 名参与者。与对照组相比，DPP-4 抑制剂可明显降低尿白蛋白肌酐比值 (UACR) 和 HbA1c 水平（UACR：SMD -0.23，95% CI：-0.41，-0.06；p = 0.01；HbA1c：SMD -0.32，95% CI：-0.51，-0.14；p = 0.0006）。在 DPP-4 抑制剂组中，UACR 至少降低 30% 的患者比例更高（OR = 1.73，95% CI：1.10, 2.73；p = 0.02）。然而，估计肾小球滤过率（eGFR）和血清肌酐（SCr）的变化在各组之间相似（eGFR：p = 1.00；SCr：p = 0.67）。在全因死亡率（OR = 0.94，95% CI：0.83，1.06；p = 0.31）或低血糖风险（OR = 1.10，95% CI：0.80，1.52；p = 0.54）方面，DPP-4 抑制剂组和对照组之间没有发现明显差异。与安慰剂或其他抗糖尿病药物相比，DPP-4 抑制剂不会增加低血糖风险，具有良好的安全性。

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Safety and Efficiency of Dipeptidyl Peptidase IV Inhibitors in Patients with Diabetic Kidney Disease: A Systematic Review and Meta-Analysis

Background

To investigate the safety and efficiency of dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with diabetic kidney disease.

Methods

We conducted a comprehensive literature search across multiple databases, including Embase, PubMed, CNKI, and the Cochrane Central Register of Controlled Trials, from inception to January 2024. The search focused on randomized controlled trials (RCTs) that directly compared DPP-4 inhibitors with placebos or other glucose-lowering therapies. A meta-analysis was performed to pool data and quantify the therapeutic effects and safety profile of DPP-4 inhibitors in DKD.

Results

Twenty-three RCTs with 16,378 participants were included. DPP-4 inhibitors significantly reduced urinary albumin-to-creatinine ratio (UACR) and HbA1c levels compared to controls (UACR: SMD -0.23, 95% CI: -0.41, -0.06; p = 0.01; HbA1c: SMD -0.32, 95% CI: -0.51, -0.14; p = 0.0006). A higher proportion of patients in the DPP-4 inhibitor group achieved at least a 30% reduction in UACR (OR = 1.73, 95% CI: 1.10, 2.73; p = 0.02). However, estimated glomerular filtration rate (eGFR) and serum creatinine (SCr) changes were similar between groups (eGFR: p = 1.00; SCr: p = 0.67). No significant differences were found in all-cause mortality (OR = 0.94, 95% CI: 0.83, 1.06; p = 0.31) or hypoglycemia risk (OR = 1.10, 95% CI: 0.80, 1.52; p = 0.54) between the DPP-4 inhibitor and control groups.

Conclusions

DPP-4 inhibitors exhibit renoprotective properties, indicated by significant reductions in UACR and HbA1c levels. They do not appear to increase the risk of hypoglycemia, presenting a favorable safety profile when compared to placebo or alternative antidiabetic agents.

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来源期刊

Current Therapeutic Research-clinical and Experimental 医学-药学

CiteScore

3.50

自引率

0.00%

发文量

审稿时长

3 months

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