中国人群糖尿病足相关危险因素的Meta分析

Risk factors of diabetic foot in China: a Meta analysis

目的通过Meta分析探讨中国人群糖尿病足相关危险因素。方法计算机检索中国期刊全文数据库(CNKI)、维普中文科技期刊全文数据库(VIP)、Pubmed、EMbase、中国生物医学文献检索数据库(CBM)和万方科技期刊全文数据库等数据库,并手工检索相关文献,检索关于中国人群糖尿病足相关危险因素的病例-对照研究,检索时限均从建库至2013年12月。由两名评价者根据纳入、排除标准独立选择文献、提取资料、评价质量后采用RevMan5.0软件进行Meta分析,用固定效应模型或随机效应模型合并比值比(OR)值及95%可信区间(CI)分析各个相关危险因素,采用敏感性分析评估结果的稳定性,用漏斗图评估文献的发表偏倚。结果共纳入15篇文献,Meta分析结果显示影响糖尿病足发生的重要危险因素有年龄(OR=7.51,95%CI:6.74~8.28)、病程(OR=3.34,95%CI:2.96~3.72)、体重指数(BMI)(OR=-0.53,95%CI:-0.80^-0.26)、收缩压(OR=9.84,95%CI:8.08~11.60)、舒张压(OR=1.03,95%CI:0.03~2.03)、空腹血糖(FPG)(OR=1.48,95%CI:1.19~1.77)、餐后2 h血糖(2 hPG)(OR=2.15,95%CI:1.71~2.59)、糖化血红蛋白(HbA1c)(OR=1.46,95%CI:1.03~1.88)、血清总胆固醇(TC)(OR=-0.31,95%CI:-0.42^-0.19)、高密度脂蛋白胆固醇(HDL-C)(OR=-0.07,95%CI:-0.10^-0.03),差异均有统计学意义(P<0.01);而甘油三酯(TG)(OR=-0.06,95%CI:-0.16~0.04)和低密度脂蛋白胆固醇(LDL-C)(OR=-0.05,95%CI:-0.21~0.11)对糖尿病足的发病与否无明显影响(P>0.05)。结论初步确定年龄、病程、BMI、收缩压、舒张压、FPG、2 hPG、HbA1c、TC、HDL-C是影响糖尿病足发生的重要危险因素,为临床上糖尿病足发生的早期防预提供依据。

Objective To use Meta analysis to evaluate the risk factors of diabetic foot in China.Methods The following databases such as China National Knowledge Infrastructure （CNKI ）,Chinese Weipu Database,Pubmed, EMbase,Chinese Biological Medicine Database（CBM）,WANFANG Database and handsearched relevant literature were searched to collect case-control studies on the related risk factors of diabetic foot in China.The retrieval time reached from inception to December,201 3.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted the data and assessed the quality.The Meta analysis was performed by RevMan 5 .0 software.The various risk factors were analyzed by fixed effect model or random effect model pooled odds ratio（OR）and 95% confidence interval （CI）,with stability evaluated by sensitivity analysis.Moreover,the funnel plot was used to assess the published bias of articles.Results A total of 1 5 articles were included,the key risk factors such as age（OR=7.51 ,95%CI：6.74-8.28）,course of disease（OR=3.34,95%CI：2.96-3.72）,body mass index（BMI）（OR=-0.53, 95%CI：-0.80-0.26）,systolic blood pressure（OR=9.84,95%CI：8.08-1 1 .60）,diastolic blood pressure（OR=1 .03,95%CI：0.03-2.03）,fasting blood glucose（FPG）（OR=1 .48,95%CI：1 .1 9-1 .77）,2 h post prandial blood glucose（2 hPG）（OR=2.15,95% CI：1.71-2.59）,glycosylated hemoglobin A1c（HbA1c）（OR=1.46,95%CI：1.03-1.88）,total cholesterol（TC）（OR=-0.31,95%CI：-0.42-0.19）and high-density lipoprotein-cholesterol （HDL-C）（OR=-0.07,95%CI：-0.1 0-0.03）（P＆lt;0.01 ）affected the happening of diabetic foot,but triglyceride （TG）（OR=-0.06,95%CI：-0.1 6-0.04）,low-density lipoprotein-cholesterol（LDL-C）（OR=-0.05,95%CI：-0.21-0.1 1 ）did not statistically influence on diabetic foot（P＆gt;0.05）.Conclusions Age,course of disease,BMI,systolic＆amp;nbsp;blood pressure,diastolic blood pressure,FPG,2 hPG,HbA1 c ,TC and HDL-C are primarily determined as the important risk factors of diabetic foot,which can provide the reference for the early prevention of diabetic foot occurred in clinic.