甘精胰岛素与非甘精胰岛素对糖尿病患者患前列腺癌风险的荟萃分析

Meta analysis of the incidence of prostate cancer in diabetes patients treated with glargine insulin or non-glargine insulin

目的甘精胰岛素能增加糖尿病(diabetes Mellitus,DM)患者患前列腺癌(prostate cancer,PCa)风险,但这些研究的结果具有争议性。因此,我们进行了Meta分析,以确定甘精胰岛素是否会增加DM患者PCa的发病率。方法检索Pubmed、Cochrane library和EMbase 3个数据中2000年至2016年的英文文献,收集了甘精胰岛素与DM患者PCa发病风险的相关研究,按纳入与排除标准筛选,并对纳入文献进行质量评价。应用Rev Man 5.0软件,用固定效应模型或随机效应模型计算相对风险(RR)和相应的95%可信区间(CI),同时进行亚组分析。结果15篇文献纳入Meta分析,研究对象有647 517人,其中PCa患者有6 049人。甘精胰岛素与非甘精胰岛素相比,在引起PCa发病率上没有显著差异(RR=1.00,95%CI=0.93~1.08,I2=0%,P=0.95)。结论我们分析的结果表明:甘精胰岛素与非甘精胰岛素相比,不会明显增加2型DM患者患PCa的发病率。但DM患者PCa的发生还受DM严重程度、种族等多种因素的影响,需要更进一步的研究证实。

Objective There has been some debate on whether insulin glargine increases the incidence of prostate cancer in patients with diabetes. Here we performed a meta-analysis to determine effects of glargine insulin on the incidence of prostate cancer in patients with diabetes. Methods Using Pubmed, Cochrane library and EMbase, we retrieved the published English literatures from 2000 to 2016 related to prostate cancer risk in diabetes patients treated with insulin glargine. According to the inclusion and exclusion criteria, we evaluate the quality of literatures. Using the RevMan 5 software and the fixed effect model or random effects model, we calculated the relative risk （RR） and the corresponding 95% confidence interval （CI）. Results Fifty articles were included in the meta analysis. The study subjects were 647517 people, including 6049 patients with prostate cancer. There was no significant difference in the incidence of prostate cancer （RR=0.96, 95%CI=0.89-1.01,P=0.2） between glargine insulin group and non-glargine insulin group. Conclusion The results indicate that glargine insulin does not significantly increase the incidence of prostate cancer in patients with diabetes compared with non-glargine insulin. However, the incidence of prostate cancer in patients with diabetes may be also associated with the severity of diabetes, race and other factors, which merits to be further investigated.