类肝素药物对2型糖尿病肾脏病患者 疗效和安全性的Meta分析.

Embase, the Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang, VIP and China biomedical literature (CBM) were searched for randomized controlled trials (RCT) and observational studies of the efficacy and safety of heparinoids in the treatment of type 2 diabetic nephropathy from inception to October 2023. Meta‑analysis was performed using RevMan 5.3 and Stata 17.0 software after the literature was screened according to the exclusion criteria, data were extracted from the literature, and the risk of bias was evaluated. Results A total of 22 trials with 3 800 patients were included. The results of the meta‑analysis showed that heparinoids could significantly reduce urinary albumin excretion in patients with type 2 diabetic kidney disease (SMD= -0.65, 95%CI -0.98--0.31, P<0.001). Subgroup analysis showed that heparinoids had an advantage over the control group in reducing urinary albumin excretion in Asian patients (SMD=-0.48, 95%CI -0.72--0.24, P<0.001), while no such advantage was observed in Europeans (SMD=-0.25, 95%CI -0.62-0.13, P=0.190). There was no significant difference between the heparinoid group and the control group in serum creatinine (SMD=-0.08, 95%CI -0.31-0.16, P=0.520), blood pressure [systolic blood pressure: WMD=-1.56 mmHg (1 mmHg=0.133 kPa), 95%CI -3.66-0.55 mmHg, P= 0.150, diastolic blood pressure: WMD=-0.16 mmHg, 95%CI -1.29-0.96 mmHg, P=0.780], fasting plasma glucose (SMD=-0.05, 95%CI -0.24-0.14, P=0.600) and glycated hemoglobin A1c (HbA1c ) (WMD=-0.07%, 95%CI -0.24%-0.10%, P=0.420) in patients with type 2 diabetic nephropathy. In terms of safety, heparinoids did not increase the incidence of adverse events such as injection site hematoma and malignant cardiovascular events (RR=1.11, 95%CI 0.97-1.28, P=0.120). Conclusion Heparinoids can effectively reduce the level of urinary albumin in patients with type 2 diabetic nephropathy, particularly in Asian patients, and there are no obvious adverse effects during the treatment. [ABSTRACT FROM AUTHOR]