高血压院外互联网管理模式有效性和安全性评估:一项融入心血管危险因素的Meta分析  

Efficacy and safety of out-of-hospital internet-based interventions on hypertension management:A Meta-analysis incorporating cardiovascular risk factors

作　　者：陈静 王深造 桑路路 鲍铁男 武文杰 邱媛 丁勇[1] CHEN Jing;WANG Shen-zao;SANG Lu-lu;BAO Tie-nan;WU Wen-jie;QIU Yuan;DING Yong

机构地区：[1]南京医科大学康达学院医学信息工程学部计算机信息技术教研室,江苏连云港222000

出　　处：《中国疗养医学》2024年第10期8-14,共7页Chinese Journal of Convalescent Medicine

基　　金：南京医科大学康达学院科研发展基金项目(KD2021KYJJZD101);南京医科大学康达医学院第二期品牌专业建设工程资助项目(JX206000302)。

摘　　要：目的融入心血管危险因素,综合评估中国高血压院外互联网管理模式的有效性和安全性。方法检索知网、万方、中国生物医学文献、维普、PubMed、Web of Science、Embase数据库,收集基于互联网对中国高血压患者进行院外管理的随机对照实验,检索时限为建库至2023年6月,采用RevMan 5.3软件进行Meta分析。结果共纳入26个研究,包括9267例高血压患者。Meta分析结果显示:干预组的高血压患者收缩压[WMD=-9.57,95%CI(-11.53,-7.62),P<0.00001]、舒张压[WMD=-5.71,95%CI(-7.78,-3.64),P<0.00001]、血压控制率[RR=1.41,95%CI(1.25,1.58),P<0.00001]、总胆固醇[WMD=-1.10,95%CI(-1.19,-1.01),P<0.00001]、三酰甘油[WMD=-0.42,95%CI(-0.49,-0.34),P<0.00001]、低密度脂蛋白[WMD=-0.88,95%CI(-1.60,-0.15),P=0.02]、高密度脂蛋白[WMD=0.34,95%CI(0.10,0.59),P=0.006]、体质指数[WMD=-0.50,95%CI(-0.80,-0.21),P=0.0008]、不良事件发生率[RR=0.32,95%CI(0.20,0.51),P<0.00001]、自我管理行为评分[WMD=19.02,95%CI(15.83,22.21),P<0.00001]的改善效果显著优于对照组,但两组患者空腹血糖[WMD=-0.10,95%CI(-0.41,0.21),P=0.52]、服药依从性评分[WMD=0.88,95%CI(-0.01,1.77),P=0.05]相比较,无显著差异。结论与常规管理相比,高血压院外互联网管理模式可以更好地改善患者的血压、血脂异常、肥胖以及自我管理能力,但在纠正糖耐量受损、提高服药依从性方面有待进一步完善。Objective To comprehensively evaluate the efficacy and safety of out-of-hospital internet-based interventions on hypertension management in China by incorporating cardiovascular risk factors.Methods Randomized controlled trials(RCTs)on the effects of Internet-based health management on hypertension patients from inception to June 2023 were searched in the China National Knowledge Infrastructure(CNKI),WanFang Data,Chinese Biomedical Literatures database(CBM),VIP,PubMed,Web of Science and Embase databases.Meta-analysis was performed using RevMan 5.3 software.Results A total of 26 RCTs involving 9267 hypertension patients were included.Meta-analysis showed better improvements in the systolic blood pressure(WMD=-9.57,95%CI-11.53,-7.62,P<0.00001),diastolic blood pressure(WMD=-5.71,95%CI-7.78,-3.64,P<0.00001),blood pressure control rate(RR=1.41,95%CI 1.25,1.58,P<0.00001),total cholesterol(WMD=-1.10,95%CI-1.19,-1.01,P<0.00001),triglycerides(WMD=-0.42,95%CI-0.49,-0.34,P<0.00001),low-densitylipoprotein(WMD=-0.88,95%CI-1.60,-0.15,P=0.02),high-densitylipoprotein(WMD=0.34,95%CI 0.10,0.59,P=0.006),body mass index(WMD=-0.50,95%CI-0.80,-0.21,P=0.0008),adverse event rate(RR=0.32,95%CI 0.20,0.51,P<0.00001)and self-management score(WMD=19.02,95%CI 15.83,22.21,P<0.00001)in the intervention group than those of the control group.However,no significant differences were observed in fasting blood glucose(WMD=-0.10,95%CI-0.41,0.21,P=0.52)and medication compliance score(WMD=0.88,95%CI-0.01,1.77,P=0.05)between two groups.Conclusion Compared with conventional health management,out-of-hospital internet-based health management has significantly better effects on improving blood pressure,dyslipidemia,obesity and selfmanagement ability for hypertension.Its role in correcting impaired glucose tolerance and improving the medication compliance still need further explorations.

关 键 词：高血压 互联网 院外管理 心血管危险因素 META分析 

分 类 号：R544.1[医药卫生—心血管疾病]