中国人糖尿病前期致病危险因素的系统评价
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摘要
目的系统评价糖尿病前期致病危险因素,为糖尿病防治及健康教育提供参考依据。方法计算机检索PubMed、EMbase、SinoMed、CNKI、WanFang Data和VIP数据库,搜集有关糖尿病前期致病危险因素的病例-对照研究,检索时限均从建库至2018年2月20日。由2名评价者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3进行meta分析。结果共纳入13个研究,包括49 168例患者。meta分析结果显示:饮酒[OR=1.31,95%CI(1.04,1.65),P=0.02]、高血压[OR=1.75,95%CI(1.11,2.76),P=0.02]、腹型肥胖[OR=1.26,95%CI(1.12,1.42),P=0.000 1]、腰臀比[OR=1.77,95%CI=(1.27,2.45),P=0.000 6]可能是糖尿病前期的风险因素。但血脂异常、吸烟、体育运动、糖尿病家族史、体重指数和腰围可能与糖尿病前期无相关性。结论当前证据显示,饮酒、高血压、腹型肥胖和腰臀比可能是糖尿病前期的影响因素,其余风险因素相关性有待进一步研究。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。
Objectives To systematically review the risk factors associated with prediabetes, and to provide reference for prevention and treatment of diabetes mellitus and health education. Methods PubMed, EMbase, SinoMed,CNKI, WanFang Data and VIP databases were electronically searched to collect case-control studies on the risk factors associated with prediabetes from inception to February 20 th, 2018. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 13 studies involving 49 168 patients were included. The results of meta-analysis showed that:drinking(OR=1.31, 95%CI 1.04 to 1.65, P=0.02), hypertension(OR=1.75, 95%CI 1.11 to 2.76, P=0.02), abdominal obesity(OR=1.26, 95%CI 1.12 to 1.42, P=0.000 1), and waist to hip ratio(OR=1.77, 95%CI 1.27 to 2.45, P=0.000 6) might be the risk factors for prediabetes. However, dyslipidemia, smoking, physical activity, family history of diabetes, body mass index and waist circumference might not be risk factors for prediabetes. Conclusions Current evidence shows that drinking,hypertension, abdominal obesity and waist-hip ratio may be the influencing factors of pre-diabetes, while other related risk factors are required to be further studied. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objectives To systematically review the risk factors associated with prediabetes, and to provide reference for prevention and treatment of diabetes mellitus and health education. Methods PubMed, EMbase, SinoMed,CNKI, WanFang Data and VIP databases were electronically searched to collect case-control studies on the risk factors associated with prediabetes from inception to February 20 th, 2018. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 13 studies involving 49 168 patients were included. The results of meta-analysis showed that:drinking(OR=1.31, 95%CI 1.04 to 1.65, P=0.02), hypertension(OR=1.75, 95%CI 1.11 to 2.76, P=0.02), abdominal obesity(OR=1.26, 95%CI 1.12 to 1.42, P=0.000 1), and waist to hip ratio(OR=1.77, 95%CI 1.27 to 2.45, P=0.000 6) might be the risk factors for prediabetes. However, dyslipidemia, smoking, physical activity, family history of diabetes, body mass index and waist circumference might not be risk factors for prediabetes. Conclusions Current evidence shows that drinking,hypertension, abdominal obesity and waist-hip ratio may be the influencing factors of pre-diabetes, while other related risk factors are required to be further studied. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
引文
1Unwin N, Shaw J, Zimmet P, et al. Impaired glucose tolerance and impaired fasting glycaemia:the current status on definition and intervention. Diabet Med, 2002, 19(9):708-723.
2 Bagheri F, Siassi F, Koohdani F, et al. Healthy and unhealthy dietary patterns are related to pre-diabetes:a case-control study. Br J Nutr, 2016, 116(5):874-881.
3Zheng S, Shi S, Ren X, et al. Triglyceride glucose-waist circumference, a novel and effective predictor of diabetes in firstdegree relatives of type 2 diabetes patients:cross-sectional and prospective cohort study. J Transl Med, 2016, 14:260.
4 Kowall B, Lehnich AT, Strucksberg KH, et al. Associations among sleep disturbances, nocturnal sleep duration, daytime napping, and incident prediabetes and type 2 diabetes:the Heinz Nixdorf Recall study. Sleep Med, 2016, 21:35-41.
5Ho CH, Yu HJ, Wang CY, et al. Prediabetes is associated with an increased risk of testosterone deficiency, independent of obesity and metabolic syndrome. PLoS One, 2013, 8(9):e74173.
6 Wells G, Shea B, Oconnell D, et al. The Newcastle-Ottawa Scale(NOS)for assessing the quality of nonrandomized studies in metaanalyses, 2000. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
7刘鸣.系统评价、Meta分析设计和实施办法.北京:人民卫生出版社, 2010:72-73.
8 何琼,黄渊秀,康文婧,等. 2001-2010年我国伤害预防病例对照研究及队列研究文献质量评价.中华疾病控制杂志, 2014,18(10):913-916.
9王丽琼,陈建华,刘春荣,等.武汉市杨园社区居民糖调节受损人群危险因素分析.中国社会医学杂志, 2017, 34(3):274-276.
10 贾会春,孙玉玲.糖尿病前期的患病情况及相关因素分析.影像研究与医学应用, 2017, 1(11):22-23.
11王培,韦丽娅,李奇观,等.广州地区糖尿病前期的患病情况及相关因素分析.广东医学, 2017, 38(7):1089-1091.
12 黄晶晶,尹莲花,许艺惠,等.肥胖、体脂率、血脂水平异常与糖尿病前期的关系探讨.湖南中医杂志, 2016, 32(6):4-6.
13王冰,刘明川,李欣宇,等.大连市40岁以上城市人群2型糖尿病及糖尿病前期患病情况及其影响因素分析.天津医科大学学报, 2016, 38(4):334-338.
14 王丹,郑代坤,郑胜.重庆市万州区2型糖尿病前期流行现状及其危险因素分析.现代预防医学, 2016, 43(10):1735-1738, 1765.
15林汉英,谢乃强,李晓莉,等.肇庆市区40岁以上人群糖尿病、糖尿病前期流行病学调查.广东医学, 2016, 37(2):285-287.
16 王瑞,周卫,谢奎,等.深圳市罗湖区居民糖尿病及其前期患病情况及影响因素.中国慢性病预防与控制, 2015, 23(4):252-255.
17苏齐,侯进.上海城郊中老年人群糖尿病前期影响因素分析.实用预防医学, 2015, 22(5):559-562.
18 陈晓英,王丛昀,苏美芳,等.社区居民糖调节受损和2型糖尿病相关因素的病例对照研究.上海预防医学, 2015, 27(11):669-672,677.
19徐忠良.天津市20-79岁居民空腹血糖受损患病率及相关因素研究.天津:天津医科大学, 2012.
20 丁红,邵洁,者炜,等.维吾尔族糖调节受损影响因素Logistic回归分析.中国民族民间医药, 2009, 18(18):7-8.
21刘立亚,陈立章,戴进雄,等.湘西地区侗族2型糖尿病危险因素的病例对照研究.中南大学学报(医学版), 2013, 38(10):1057-1064.
22 陈瑞芳,常少琼.糖尿病前期危险因素分析及八段锦的运用.光明中医, 2013, 28(12):2531-2533.
23中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中国医学前沿杂志(电子版), 2015, 7(3):26-89.
24 Tao LX, Yang K, Huang FF, et al. Association of waist circumference gain and incident prediabetes defined by fasting glucose:a seven-year longitudinal study in Beijing, China. Int J Environ Res Public Health, 2017, 14(10):E1208.
25汪秋实,闫丽,吕淑荣,等.糖尿病前期人群血脂异常及其危险因素分析.东南大学学报(医学版), 2015, 34(5):749-754.
26 张扬,王明杰,刘鑫,等.吉林省成年居民糖尿病前期患病情况及其危险因素分析.中国公共卫生, 2018, 34(7):977-981.
27张辉映,袁旻健,娄灵芝,等.糖尿病前期人群血糖水平的影响因素分析.上海预防医学, 2011, 23(5):207-209.
28薛安红.腹型肥胖2型糖尿病的治疗体会.中国医疗前沿, 2010,5(1):36.
2 Bagheri F, Siassi F, Koohdani F, et al. Healthy and unhealthy dietary patterns are related to pre-diabetes:a case-control study. Br J Nutr, 2016, 116(5):874-881.
3Zheng S, Shi S, Ren X, et al. Triglyceride glucose-waist circumference, a novel and effective predictor of diabetes in firstdegree relatives of type 2 diabetes patients:cross-sectional and prospective cohort study. J Transl Med, 2016, 14:260.
4 Kowall B, Lehnich AT, Strucksberg KH, et al. Associations among sleep disturbances, nocturnal sleep duration, daytime napping, and incident prediabetes and type 2 diabetes:the Heinz Nixdorf Recall study. Sleep Med, 2016, 21:35-41.
5Ho CH, Yu HJ, Wang CY, et al. Prediabetes is associated with an increased risk of testosterone deficiency, independent of obesity and metabolic syndrome. PLoS One, 2013, 8(9):e74173.
6 Wells G, Shea B, Oconnell D, et al. The Newcastle-Ottawa Scale(NOS)for assessing the quality of nonrandomized studies in metaanalyses, 2000. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
7刘鸣.系统评价、Meta分析设计和实施办法.北京:人民卫生出版社, 2010:72-73.
8 何琼,黄渊秀,康文婧,等. 2001-2010年我国伤害预防病例对照研究及队列研究文献质量评价.中华疾病控制杂志, 2014,18(10):913-916.
9王丽琼,陈建华,刘春荣,等.武汉市杨园社区居民糖调节受损人群危险因素分析.中国社会医学杂志, 2017, 34(3):274-276.
10 贾会春,孙玉玲.糖尿病前期的患病情况及相关因素分析.影像研究与医学应用, 2017, 1(11):22-23.
11王培,韦丽娅,李奇观,等.广州地区糖尿病前期的患病情况及相关因素分析.广东医学, 2017, 38(7):1089-1091.
12 黄晶晶,尹莲花,许艺惠,等.肥胖、体脂率、血脂水平异常与糖尿病前期的关系探讨.湖南中医杂志, 2016, 32(6):4-6.
13王冰,刘明川,李欣宇,等.大连市40岁以上城市人群2型糖尿病及糖尿病前期患病情况及其影响因素分析.天津医科大学学报, 2016, 38(4):334-338.
14 王丹,郑代坤,郑胜.重庆市万州区2型糖尿病前期流行现状及其危险因素分析.现代预防医学, 2016, 43(10):1735-1738, 1765.
15林汉英,谢乃强,李晓莉,等.肇庆市区40岁以上人群糖尿病、糖尿病前期流行病学调查.广东医学, 2016, 37(2):285-287.
16 王瑞,周卫,谢奎,等.深圳市罗湖区居民糖尿病及其前期患病情况及影响因素.中国慢性病预防与控制, 2015, 23(4):252-255.
17苏齐,侯进.上海城郊中老年人群糖尿病前期影响因素分析.实用预防医学, 2015, 22(5):559-562.
18 陈晓英,王丛昀,苏美芳,等.社区居民糖调节受损和2型糖尿病相关因素的病例对照研究.上海预防医学, 2015, 27(11):669-672,677.
19徐忠良.天津市20-79岁居民空腹血糖受损患病率及相关因素研究.天津:天津医科大学, 2012.
20 丁红,邵洁,者炜,等.维吾尔族糖调节受损影响因素Logistic回归分析.中国民族民间医药, 2009, 18(18):7-8.
21刘立亚,陈立章,戴进雄,等.湘西地区侗族2型糖尿病危险因素的病例对照研究.中南大学学报(医学版), 2013, 38(10):1057-1064.
22 陈瑞芳,常少琼.糖尿病前期危险因素分析及八段锦的运用.光明中医, 2013, 28(12):2531-2533.
23中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中国医学前沿杂志(电子版), 2015, 7(3):26-89.
24 Tao LX, Yang K, Huang FF, et al. Association of waist circumference gain and incident prediabetes defined by fasting glucose:a seven-year longitudinal study in Beijing, China. Int J Environ Res Public Health, 2017, 14(10):E1208.
25汪秋实,闫丽,吕淑荣,等.糖尿病前期人群血脂异常及其危险因素分析.东南大学学报(医学版), 2015, 34(5):749-754.
26 张扬,王明杰,刘鑫,等.吉林省成年居民糖尿病前期患病情况及其危险因素分析.中国公共卫生, 2018, 34(7):977-981.
27张辉映,袁旻健,娄灵芝,等.糖尿病前期人群血糖水平的影响因素分析.上海预防医学, 2011, 23(5):207-209.
28薛安红.腹型肥胖2型糖尿病的治疗体会.中国医疗前沿, 2010,5(1):36.
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