2型糖尿病患者心脏自主神经病变影响因素的Meta分析  

Meta-analysis of Influencing Factors of Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus

作　　者：刘雨桐 柳洪宙[2] 张雪莲[3] LIU Yu-tong;LIU Hong-zhou;ZHANG Xue-lian(The Fourth Clinical Medical College of Capital Medical University,Beijing 100730,China;The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Endocrinology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学第四临床医学院,北京100730 [2]解放军总医院第一医学中心,北京100853 [3]首都医科大学附属北京同仁医院内分泌科,北京100730

出　　处：《医学信息》2023年第11期50-59,66,共11页Journal of Medical Information

基　　金：首都临床特色应用研究项目(编号:Z151100004015021);国家自然科学基金资助项目(编号:81300726)。

摘　　要：目的系统评价2型糖尿病(T2DM)患者心脏自主神经病变(CAN)的影响因素。方法检索PubMed、EMbase、Cochrane Library、Web of Science、中国知网、中国生物医学文献数据库、万方及维普数据库中有关T2DM患者CAN影响因素的研究,检索时限为建库至2022年2月,对纳入文献进行质量评价。病例组为T2DM合并CAN患者(CAN组),对照组为T2DM未合并CAN患者(非CAN组)。收集患者一般资料、生化资料、并发症资料,利用RevMan5.3进行Meta分析,采用漏斗图分析纳入相关指标的文献是否存在发表偏倚。结果最终共纳入24篇文献,包括12244例T2DM患者,CAN组4236例(34.60%),涉及影响因素27个,Meta分析结果显示,两组年龄、性别、糖尿病病程、收缩压、脉压、腰围、静息心率、使用胰岛素、三酰甘油、高密度脂蛋白胆固醇、糖化血红蛋白、尿酸、空腹血糖、胰岛素抵抗指数(HOMA-IR)、肾小球滤过率(eGFR)比较,差异有统计学意(P<0.05);漏斗图分析显示,上述文献发表可能存在偏倚。结论年龄、糖尿病病程、收缩压、脉压、腰围、静息心率、使用胰岛素、三酰甘油、糖化血红蛋白、尿酸、空腹血糖、HOMA-IR、e GFR可能是T2DM患者CAN的影响因素,高密度脂蛋白胆固醇可能是T2DM患者CAN的保护因素,尚不能确定男性与T2DM患者CAN有关。Objective To systematically evaluate the influencing factors of cardiac autonomic neuropathy(CAN)in patients with type 2 diabetes mellitus(T2DM).Methods PubMed,EMbase,Cochrane Library,Web of Science,CNKI,CBM,Wanfang and VIP databases were searched for studies on the influencing factors of CAN in T2 DM patients.The retrieval time was from the establishment of the database to February 2022,and the quality of the included literature was evaluated.The case group was T2DM patients with CAN(CAN group),and the control group was T2DM patients without CAN(non-CAN group).The general data,biochemical data and complication data of patients were collected and analyzed by RevMan5.3.The funnel plot was used to analyze whether there was publication bias in the literature included in the relevant indicators.Results Finally,a total of 24 literatures were included,including 12244 patients with T2DM,and 4236 patients(34.60%)in the CAN group,involving 27 influencing factors.The results of Meta-analysis showed that there were significant differences in age,gender,duration of diabetes,systolic blood pressure,pulse pressure,waist circumference,resting heart rate,use of insulin,triglyceride,high-density lipoprotein cholesterol,glycosylated hemoglobin,uric acid,fasting blood glucose,insulin resistance index(HOMA-IR)and glomerular filtration rate(eGFR)between the two groups(P<0.05).Funnel plot analysis showed that there might be bias in the publication of the above literature.Conclusion Age,duration of diabetes,systolic blood pressure,pulse pressure,waist circumference,resting heart rate,use of insulin,triglyceride,glycosylated hemoglobin,uric acid,fasting blood glucose,HOMA-IR,eGFR may be the influencing factors of CAN in T2DM patients.High-density lipoprotein cholesterol may be a protective factor for CAN in T2DM patients,but it is not certain that maleare associated with CAN in T2DM.

关 键 词：糖尿病心脏自主神经病变 2型糖尿病 静息心率 高密度脂蛋白胆固醇 

分 类 号：R587.1[医药卫生—内分泌]