超重/肥胖与骨性关节炎在中国人群中的相关性系统评价

A systematic review of the correlation between overweight/obesity and osteoarthritis in Chinese population

目的评价中国人群中超重和肥胖与骨性关节炎之间的相关性。方法中英文均以"超重、肥胖、骨性关节炎、病例对照研究、队列研究"为检索词。计算机检索中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊全文数据库、万方数字化期刊全文数据库和Pub Med、Embase、Cochrane library及相关临床注册中心数据库,并浏览已被纳入文献的参考文献。由两位作者按照纳入和排除标准筛选文献,提取资料。采用Newcastle-Ottawa Scale(NOS)文献质量评价量表对符合纳入标准的文献进行质量评价,并采用Rev Man 5.3软件对纳入的文献进行Meta分析。结果共纳入4项病例对照研究,合计12 295例患者,其中膝骨关节炎组2 127例,非骨性关节炎组10 168例。NOS量表评分提示1项研究质量较高,3项研究质量较低。Meta分析结果表明,膝骨关节炎人群中的肥胖人数是非膝骨关节炎人群的2.06倍,两者比较差异有统计学意义(RR=2.06,95%可信区间[1.43,2.95],P<0.0001)。Begg检验中,"Pr>|z|=0.089"表明本研究存在明显的发表偏倚。Egger检验中,"P>|t|"指标为0.291,表明本研究中不存在明显的发表偏倚。综合两个检验结果,不能明确有无发表偏移。结论超重和肥胖是膝骨关节炎发生发展的影响因素之一,因此,预防肥胖可能是减少膝骨关节炎的一个途径。但目前国内相关研究设计不规范,报告质量较低,结局指标不完整,样本量少等,故需设计高质量的文献,以提高相关研究的证据级别和强度。

ObjectiveTo evaluate the correlation between overweight/obesity and osteoarthritis in Chinese population.Methods In both English and Chinese, the terms ＆quot;overweight, obesity, osteoarthritis, case control study, cohort study＆quot; were used as search terms. The major Chinese biomedical databases （CBM, CNKI, VIP, Wanfang） , PubMed, Embase, Cochrane library and related clinical registry database were searched, and the references of included literatures were also screened. These literatures were selected and the related data were extracted by two authors according to the inclusion and exclusion criteria. The Newcastle-Ottawa Scale（NOS）was used to evaluate the quality of the included studies, and RevMan 5.3 software was used for meta-analysis.Results Four case-control studies which included 12 295 patients were included. Among all the patients, 2 127 were included into the knee osteoarthritis group, and the other 10 168 patients were included into the non-osteoarthritis group. The NOS score indicated that there were one high-quality study, and three low-quality studies. The meta analysis showed that the number of obese people in the knee osteoarthritis group was 2.06 times more than that of the non knee osteoarthritis group, and there was a statistical difference between the two groups （RR=2.06, 95% confidence interval[1.43, 2.95],P〈0.0001）. In Begg test,“Pr〉｜z｜= 0.089”showed that there was an obvious published bias. In Egger test, the index of“P〉｜t｜” equaled 0.291 which showed that there was no obvious bias in these studies. According to the two test results, it can not be defined whether published bias existed or not.Conclusions Overweight and obesity belong to the factors that can influence the development of knee osteoarthritis. Therefore, prevention of obesity may be a way to reduce knee osteoarthritis. But most of the current domestic research are not well designed, their quality are relatively low, outcomes are not complete and sample sizes are small; so it is necessary to design trials with high quality to improve the level and strength of evidences.