背景:已经提出了新的生物标志物用于糖尿病的诊断和预后。已经研究了netrin-1作为细胞外蛋白在糖尿病中的生物标志物用途。在这篇系统综述和荟萃分析中,我们回顾了netrin-1作为糖尿病前期生物标志物的作用,糖尿病,和糖尿病并发症。
方法:PubMed,Embase,Scopus,和WebofScience进行了系统的搜索,以测量糖尿病患者的循环和/或尿液中的netrin-1水平,并将其与非糖尿病患者进行比较或评估该标志物的预后作用。使用随机效应荟萃分析计算标准化平均差异(SMD)和95%置信区间(CI),以比较组间的netrin-1水平。平均年龄的影响,男性比例,样本量,平均体重指数,使用meta回归评估总体异质性的发表年份。
结果:在来自国际数据库的413条记录中,纳入19项原始研究,共2061例(1137例糖尿病患者,196名前驱糖尿病患者,和728名健康对照)。对八项在糖尿病患者中测量netrin-1并将其与健康对照组进行比较的研究的荟萃分析显示,两组之间没有显着差异(SMD0.69,95%CI-0.78至2.16,I2=98%,p值=0.36)。另一方面,一项对糖尿病前期患者的netrin-1水平与健康对照组比较的荟萃分析显示,糖尿病前期患者的netrin-1水平较低(SMD-0.51,95%CI-0.81~-0.21,p值<0.01).与正常白蛋白尿组SMD1.18,95%CI0.83至1.53,p值<0.01和SMD1.67,95%CI0.76至2.58,p值<0.01)相比,具有微量白蛋白尿和大量白蛋白尿的糖尿病患者的循环netrin-1水平明显更高。此外,尿液中的netrin-1水平没有差异,宏-,和正常白蛋白尿组(p值>0.05)。
结论:Netrin-1作为糖尿病预后的生物标志物显示出有希望的结果。然而,需要更多的研究来证实我们的发现,并且需要更高的样本量研究来评估该标记的诊断实用性。
BACKGROUND: Novel biomarkers have been suggested for the diagnosis and prognosis of diabetes mellitus. The biomarker utility of netrin-1 in diabetes as an extracellular protein has been investigated. In this systematic
review and meta-analysis, we reviewed the role of netrin-1 as a biomarker in prediabetes, diabetes, and complications of diabetes.
METHODS: PubMed, Embase, Scopus, and Web of Science were systematically searched for studies that measured circulatory and/or urinary netrin-1 levels in diabetes and compared them with non-diabetic patients or evaluated the prognostic role of this marker. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated using random-effect meta-analysis to compare netrin-1 levels between groups. The impact of mean age, male sex percentage, sample size, mean body mass index, and publication year on the overall heterogeneity was assessed using meta-regression.
RESULTS: Among 413 records from international databases, 19 original studies were included with 2061 cases (1137 diabetics, 196 prediabetics, and 728 healthy controls). Meta-analysis of eight studies measuring netrin-1 in patients with diabetes and comparing it with healthy controls showed no significant difference between the two groups (SMD 0.69, 95% CI -0.78 to 2.16, I2 = 98%, p-value = 0.36). On the other hand, a meta-analysis of netrin-1 levels in patients with prediabetes in comparison with healthy controls revealed that they had lower levels (SMD -0.51, 95% CI -0.81 to -0.21, p-value < 0.01). Diabetic patients with microalbuminuria and macroalbuminuria had significantly higher circulatory netrin-1 levels compared to normoalbuminuric group SMD 1.18, 95% CI 0.83 to 1.53, p-value < 0.01 and SMD 1.67, 95% CI 0.76 to 2.58, p-value < 0.01, respectively). Moreover, no difference in urinary netrin-1 levels was found between micro-, macro-, and normoalbuminuric groups (p-value > 0.05).
CONCLUSIONS: Netrin-1 showed promising results as a biomarker in diabetes prognosis. However, more studies are required to confirm our findings, and higher sample size studies are needed to evaluate the diagnostic utility of this marker.