糖尿病前期与肾病之间的关联：一项全面的系统综述与荟萃分析。
完整摘要 · 中文译文
背景：本研究探讨糖尿病前期与肾病之间的关联，重点关注慢性肾脏病以及肾小球滤过率和尿白蛋白与肌酐比值等关键指标。 方法：对2024年11月之前发表的研究进行系统综述，纳入26篇文章，包括15项队列研究和11项横断面研究，涵盖350，546名糖耐量正常个体和146，547名糖尿病前期个体。采用随机效应限制性最大似然模型评估慢性肾脏病、肾小球滤过率和尿白蛋白与肌酐比值。慢性肾脏病的风险使用相对危险度（RR）及95%置信区间报告，而肾小球滤过率和尿白蛋白与肌酐比值则使用均数差（MD）。发表偏倚和方法学质量分别采用Egger回归检验和美国国家心肺血液研究所质量评估工具进行评估。敏感性采用留一法进行检验。 结果：来自19项研究的数据显示，糖尿病前期个体发生慢性肾脏病的风险更高（RR：1.53；95% CI：1.30-1.81；P < 0.001），当三种诊断方法均使用时，该风险升至1.21（95% CI：1.78-2.73）。在31项观测中，肾小球滤过率下降（MD：- 2.85；95% CI：- 4.57至- 1.13；P = 0.001）。尿白蛋白与肌酐比值在21项观测中升高（MD：0.87；95% CI：0.19-1.55；P = 0.012）。在亚洲观察到的关联强于欧洲或美国。 结论： SION：糖尿病前期与较低的肾小球滤过率和较高的尿白蛋白与肌酐比值相关，提示慢性肾脏病风险增加。早期干预可能有益。
完整摘要 · 英文原文
BACKGROUND: This study examines the association between prediabetes and nephropathy, focusing on chronic kidney disease and key indicators such as glomerular filtration rate and urinary albumin-to-creatinine ratio. METHODS: A systematic review of studies published before November 2024 included 26 articles, 15 cohort studies, and 11 cross-sectional studies, covering 350,546 individuals with normal glucose tolerance and 146,547 with prediabetes. A random-effects restricted maximum likelihood model was used to assess chronic kidney disease, glomerular filtration rate, and urinary albumin-to-creatinine ratio. The risk of chronic kidney disease was reported using relative risk (RR) with 95% confidence intervals, while mean difference (MD) was used for glomerular filtration rate and urinary albumin-to-creatinine ratio. Publication bias and methodological quality were assessed using the Egger regression test and the National Heart, Lung, and Blood Institute quality assessment tools. Sensitivity was tested using a leave-one-out method. RESULTS: Data from 19 studies showed that individuals with prediabetes had a higher risk of developing chronic kidney disease (RR: 1.53; 95% CI: 1.30-1.81; P < 0.001), rising to 1.21 (95% CI: 1.78-2.73) when all three diagnostic methods were used. Across 31 observations, glomerular filtration rate declined by (MD: - 2.85; 95% CI: - 4.57 to - 1.13; P = 0.001). Urinary albumin-to-creatinine ratio increased in 21 observations (MD: 0.87; 95% CI: 0.19-1.55; P = 0.012). Stronger associations were observed in Asia than in Europe or the United States. CONCLUSION: Prediabetes is linked to lower glomerular filtration rate and higher urinary albumin-to-creatinine ratio, indicating increased risk of chronic kidney disease. Early intervention may be beneficial.