2型糖尿病患者发生认知功能障碍危险因素的Meta分析

A meta-analysis of risk factors of cognitive impairment in patients with type 2 diabetes

目的系统评价2型糖尿病认知功能障碍危险因素。方法通过检索中英文数据库,筛选符合纳入标准的队列研究文献,应用Rev Man 5.3分析软件对资料进行分析。结果 1 910篇文献中21篇文献符合纳入标准,共纳入40个危险因素。经Meta分析,合并效应量具有统计学意义的RR值(95%CI)分别为女性1.21(1.16,1.25)、受教育程度0.81(0.77,0.85)、低血糖1.34(1.26,1.42)、脑血管疾病史1.46(1.08,1.99)、卒中史2.23(1.51,3.28)、肾病1.45(1.39,1.52)、视网膜病变1.35(1.21,1.51)、神经病变1.14(1.06,1.23)、降糖药物的使用1.10(1.04,1.16)、胰岛素的使用1.43(1.33,1.54)、抑郁1.38(1.32,1.45)。结论女性、低血糖、脑血管疾病史、卒中史、肾病、视网膜病变、神经病变、降糖药物使用、胰岛素使用、抑郁是认知功能障碍的危险因素,受教育程度是认知障碍的保护因素,而年龄、种族、糖尿病足、糖化血红蛋白、高血脂、高血压与认知功能障碍的关系在本研究中显示无统计学意义,有待开展大样本前瞻性队列研究予以验证。

Objective To analyze the risk factors for cognitive impairment in patients with type 2 diabetes.Methods The cohort studies related to the risk factors of cognitive impairment were searched according to the inclusion and exclusion criteria.Meta-analysis was calculated using RevMan 5.3.Results Twenty-one studies were identified among 1910 papers and 40 risk factors were involved.The following factors had cumulative effects on cognitive impairment.The RR and 95%CI of each risk factor were as follow:female 1.21(1.16,1.25),educational level 0.81(0.77,0.85),hypoglycaemic episodes 1.34(1.26,1.42),cerebrovascular disease 1.46(1.08,1.99),stroke 2.23(1.51,3.28),nephropathy 1.45(1.39,1.52),retinopathy 1.35(1.21,1.51),neuropathy 1.14(1.06,1.23),oral antidiabetic 1.10(1.04,1.16),insulin 1.43(1.33,1.54),and depression 1.38(1.32,1.45).Conclusion Female,education,hypoglycaemic episodes,cerebrovascular disease,stroke,nephropathy,retinopathy,neuropathy,oral antidiabetic,insulin,and depression were predictors of cognitive impairment in type 2 diabetes,while meta-analysis failed to support the factors of age,race,diabetic foot,HbA1c,hypertension,and hyperlipidaemia as predictors.