利尿药与老年人跌倒风险关系的系统评价

Systematic review of the association of diuretics with falls in the elderly

目的系统评价利尿药与老年人跌倒风险的关系。方法计算机检索MEDLINE、Embase、CENTRAL、AMED、CINAHL、Web of Science、Wiley Online Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中国科技期刊全文数据库(VIP)和万方数据库,检索日期为建库至2017年7月。收集利尿药与老年人跌倒风险关系的病例对照研究和队列研究,对纳入研究采用纽卡斯尔-渥太华量表进行质量评价,使用Rev Man 5.3软件对数据进行Meta分析。结果共纳入17项研究(7项病例对照研究、10项队列研究),78 284例患者。(1)病例对照研究:未校正OR值合并显示,利尿药不会增加老年人跌倒的风险[OR=0.95,95%CI(0.66,1.38),P=0.80];校正OR值合并显示,利尿药会增加老年人跌倒的风险[校正OR=1.25,95%CI(1.15,1.36),P<0.05)。(2)队列研究:未校正OR值合并显示,利尿药会增加老年人跌倒的风险[OR=1.16,95%CI(1.02,1.32),P=0.03];校正OR值合并显示,利尿药不会增加老年人跌倒的风险[校正OR=1.06,95%CI(0.92,1.22),P=0.43]。(3)不同研究场所下和不同种类利尿药在老年人跌倒风险的分析中无统计学意义(P>0.05)。基于控制了混杂因素的队列研究Meta分析结果,以及不同场所和不同种类利尿药的分析结果,表明利尿药不会增加老年人跌倒的风险。结论利尿药不会增加老年人跌倒的风险,鉴于纳入研究的数量与质量的局限性,结果尚需更严谨的临床试验进一步验证。

Objective To systematically evaluate the association of diuretics with falls in the elderly. Methods Data of case-control studies and cohort studies of diuretics with falls in the elderly were collected by searching eleven electronic databases：MEDLINE,Embase,CENTRAL,AMED,CINAHL,Web of Science,Wiley online library, CBM,CNKI,VIP and WanFang Data from inception to July 2017. Study quality was assessed by the NOS scale. Meta-analysis was conducted by RevMan 5.3 software. Results A total of 17 studies involving 78 284 patients were included（seven case-control studies and ten cohort studies）. Meta-analysis showed that：（1）Case-control studies： crude OR showed that diuretics would not increase the risk of falls in elderly patients [OR =0.95,95% CI （0.66,1.38） ,P=-0.801 ;adjusted OR showed that diuretics would increase the risk of falls in elderly patients[adjusted 0R=1.25,95%CI （1.15,1.36）,P〈0.05]. （2）Cohort studies：crude OR showed that diuretics would increase the risk of fails in elderly patients [ OR= 1.16,95%CI （1.02,1.32）, P=-0.03 ] ; adjusted OR showed that diuretics would not increase the risk of fails in elderly patients[adjusted OR=1.06,95%CI（0.92,1.22）,P=0.43]. （3）There was no statistically significant difference in the risk of falls among the elderly at different places ,and there was no significant difference in the risk of falls among various diuretics （P〉0.05）. Conclusion Based on meta-analysis results of cohort studies that controlled confounders,and the results of diuretics in different places and different kinds,diuretics will not increase the risk of falls in older adults. Due to limited quantity and quality of included studies,the results need to be further confirmed by more rigorous clinical trials in the future.