体位性低血压和主要心血管疾病:一项系统综述和荟萃分析  

Orthostatic hypotension and major cardiovascular diseases:a systematic review and meta-analysis

作　　者：陈婉婷 蔡文钦[2] 滕忠铭[1] 姚月娴 鲍玲鑫[1] CHEN Wanting;CAI Wenqin;TENG Zhongming;YAO Yuexian;BAO Lingxin(College of Computer and Information Sciences,Fujian Agriculture and Forestry University,Fuzhou,Fujian 350002,China;Department of Geriatrics,Fujian Hypertension Research Institute,the First Affiliated Hospital,Fujian Medical University,Department of Geriatrics,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University;Department of Rehabilitation Medicine,Fujian Provincial Geriatric Hospital,Department of Geriatrics,Fujian Provincial Geriatric Hospital)

机构地区：[1]福建农林大学计算机与信息学院,福建福州350002 [2]福建医科大学附属第一医院老年医学科,福建省高血压研究所,福建医科大学附属第一医院滨海院区国家区域医疗中心老年医学科 [3]福建省老年医院康复医学科,福建省老年医院老年医学科

出　　处：《中华高血压杂志(中英文)》2025年第2期163-170,共8页Chinese Journal of Hypertension

基　　金：福建省自然科学基金(2023J01471);福建农林大学科技创新特别基金(KFB23159);福建省大学智能农林重点实验室专项资助基金(KJG23033A)。

摘　　要：目的 探讨体位性低血压与主要心血管疾病(包括心力衰竭、冠心病及脑卒中)的关系。方法 通过PubMed、Web of Science、Cochrane Library、中国知网(CNKI)、维普数据库(VIP)、万方数据知识服务平台等资源数据库对研究体位性低血压与主要心血管疾病关系的文献进行系统检索。检索期限为数据库建库时间至2023年11月30日。利用风险比(HR)进行荟萃分析。结果 纳入6项前瞻性研究,随访时间为3~26年。所有纳入文献的质量评分均≥4分,总体研究呈现高质量水平。荟萃分析结果显示:体位性低血压与心力衰竭(HR=1.37,95%CI 1.24~1.52)、冠心病(HR=1.47,95%CI 1.04~2.07)及脑卒中(HR=1.60,95%CI 1.32~1.93)风险增加相关。亚组结果分析显示:随访年限是冠心病研究间存在异质性的原因。敏感性分析结果显示:对于心力衰竭及脑卒中,荟萃分析结果总体稳健性较好;对于冠心病,敏感性分析结果不稳定。体位性低血压与心力衰竭、冠心病及脑卒中关系的漏斗图呈现不对称性,提示存在发表偏倚。利用剪补法校正后,漏斗图呈现出对称性。结论 体位性低血压增加心力衰竭、冠心病及脑卒中发生的风险,但冠心病与体位性低血压之间的敏感性分析结果不稳定,还需进一步研究。Objective To investigate the relationship between orthostatic hypotension and major cardiovascular diseases,including heart failure,coronary heart disease(CHD),and stroke.Methods The literature on the relationship between orthostatic hypotension and major cardiovascular diseases was systematically searched using databases such as PubMed,Web of Science,Cochrane Library,CNKI(China National Knowledge Infrastructure),VIP database,and Wanfang Data Knowledge Service Platform from inception up to November 30,2023.A meta-analysis was conducted using hazard ratios(HR)value as statistics.Results Six prospective studies were included in this metaanalysis.The follow-up time was 3 to 26 years.The quality scores of included literature were all≥4,indicating a high-quality level.The meta-analysis results showed that orthostatic hypotension increased the risk of heart failure(HR=1.37,95%CI:1.24-1.52),CHD(HR=1.47,95%CI:1.04-2.07),and stroke(HR=1.60,95%CI:1.32-1.93).Subgroup analysis showed that follow-up duration was a cause of heterogeneity in the analysis for CHD.Sensitivity analysis showed that in the analysis for heart failure and stroke,the results were generally robust,while in the analysis for CHD,the result was not robust.The funnel plot for orthostatic hypotension in relation to heart failure,CHD,and stroke showed asymmetry,indicating the presence of publication bias.After correction using the trim-and-fill method,the funnel plot exhibited symmetry.Conclusions Orthostatic hypotension is potentially associated with heart failure,CHD and stroke.However,the sensitivity analysis regarding the relationship between CHD and orthostatic hypotension indicates that the results is unstable,and further research is needed.

关 键 词：体位性低血压 心血管疾病 荟萃分析 

分 类 号：R54[医药卫生—心血管疾病]