非奈利酮治療2型糖尿病腎病有效性和安全性的Meta分析

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【中圖分類號】 R587.24 【文獻標識碼】 ADOI： 10.12114/j.issn.1007-9572.2024.0526

【Abstract】BackgroundFinerenone，a nonsteroidal mineralocorticoid antagonist，is anovel therapeuticagent forrenalprotectioninpatients withdiabetic kidneydisease，joiningtheranksofangiotensin-convertingenzyeinhibitorsand sodium-glucosecotransporter2inhibitorsinprovidingrenalprotectionforsuchpatients.Recently，twometa-analysesfocusing onpatientswithchronickidneydiseasehaveyieldedconflictingconclusionsregardingtheimpactoffinerenoneonthedeclineof estimatedglomerularfiltrationrate（eGFR）.Inlightof this，thepresentmeta-analysisspecificalltargets thepopulation with type2diabetes，aiming tothoroughly investigatetheeficacyandsafetyoffinerenone.ObjectiveTosystematically evaluate theeficacyandsafetyoffnerenoneinpatientswithtype2diabetesandkidneydisease.MethodsAcomputerizedearchwas conductedintheCochraneLibrary，WebofScience，Embase，andPubMeddatabases，covering theperiodfromtheir inception toApril2O24.Literature wasscreenedanddataextractedaccordingtotheinclusionandexclusioncriteria.Meta-analysis was performed usingRevman 5.3，comparing indicators such as theurinealbumin-to-creatinineratioandestimatedglomerular filtrationrateintype2diabetespatientstreatedwith finerenone.ResultsAtotalof7articleswereultimatelyincluded，involving15528patients.Theresultsshowedthatcomparedwiththecontrol group，interventiongroup（usingfinerenone）had statisticallysignificantdiferencs intheurinealbumin-tocreainineratio（SMD=-0.46，95%CI=-0.48to-0.39，P<0.05）， estimated glomerular filtration rate （SMD=-0.15，95%CI=-0.19 to-0.10， P <0.05），renal composite endpoint（OR=0.83， 95%CI=0.75 to 0.92，P<0.05），all-cause mortality（OR=0.88，95%CI=0.78 to 0.99，P<0.05），and end-stage renal disease （0R=0.88，95%CI=0.78 to 0.99， P <0.05）.Compared with the control group，intervention group significantly increased the risk of hyperkalemia（OR=2.13，95%CI=1.89 to 2.39， P <0.05）.Conclusion Finerenone can significantly improve renalcomposite endpoint events in patients withtype2diabetes and kidney disease，reducetheurine albumin-to creatinineratio，andslowdownthedeclineofestimatedglomerularfiltrationrate；however，atentionshouldbepaidtoherisk of hyperkalemia during treatment.

【Key words】 Finerenone；Diabetic nephropathies；Safety；Efficacy；Meta-analysis

糖尿病已被廣泛認可為慢性腎臟?。╟hronic kidneydisease，CKD）的一個主要誘因，全球CKD病例中約60% 是由糖尿病發(fā)展而來。（剩余12045字）