夜间低血压作为正常眼压性青光眼致病因素的Meta分析

A meta-analysis of nocturnal hypotension as a risk factor for normal intraocular glaucoma

目的:系统评价夜间低血压与正常眼压性青光眼(Normal-Tension Glaucoma,NTG)发生、发展的相关性,为NTG的临床诊断、预防和治疗提供理论指导。方法:搜索在PubMed、Embase、中国生物医学文献数据库(China Biology Medicine disc,CBMdisc)、中国知网数据库(China National Knowledge Infrastructure,CNKI)、万方数据库等数据库公开发表的,并且符合标准的关于比较NTG与正常人群夜间血压的前瞻性研究和横断面研究。研究文献的筛选是基于文献的研究类型、纳入标准和排除标准,而文献质量评估则采用美国医疗保健研究与质量局(The Agency for Healthcare Research and Quality,AHRQ)公布的11项评估表。研究的合并效应值加权均数差(Weighted Mean Difference,WMD)则是使用Review Manager 5.2软件来计算。结果:最终纳入3项前瞻性研究和1项横断面研究,共计247例参与者。使用随机效应模型下的NTG患者与正常对照组相比夜间收缩压(Systolic Blood Pressure,SBP)在统计学上显著降低(P=0.04),异质性检验(χ^2=7.43,P=0.06,I 2=60%)。使用固定效应模型下的NTG患者与正常对照组相比夜间舒张压(Diastolic Blood Pressure,DBP)在统计学上显著降低(P=0.0002),异质性检验(χ^2=3.28,P=0.35,I 2=9%)。结论:Meta分析表明,与正常对照组相比,NTG患者夜间血压(包括收缩压和舒张压)均发生明显降低,提示夜间低血压有可能是NTG发病的一项重要的危险因素,这无疑为NTG的临床诊断、预防和治疗提供了一种非常有价值的思路和方法。

Objective:To evaluate systematically about the correlation between nocturnal hypotension and progress of normal-tension glaucoma(NTG),and to provide helpful advice for the clinical diagnosis,precaution and treatment of NTG.Methods:The research was done about the relative standard prospective study and cross-sectional study about risk factors for normal intraocular glaucoma patients or studies published in PubMed,Embase,CBM,CNKI and WanFang Data that compared nighttime blood pressure in normal-tension glaucoma patients with that in normal people.The studies were selected on the basis of the difference of study type,inclusion criteria and exclusion criteria.the quality evaluation of our studies was performed using 11-item evaluation sheet which announced by Agency for Healthcare Research and Quality(AHRQ).And the pooled weighted mean difference(WMD)was calculated with Review Manager 5.2 software.Results:Ultimately,three prospective studies and one cross-sectional study were included,including 247 participants.Nocturnal systolic blood pressure(SBP)was statistically significantly reduced in NTG eyes compared with normal controls of random effect model(P=0.04),with significant heteroge-neity(χ^2=7.43,P=0.06,I 2=60%).And nocturnal diastolic blood pressure(DBP)was statistically significantly reduced in NTG eyes compared with normal controls of fixed effect model(P=0.0002)with significant homogeneity(χ^2=3.28,P=0.35,I 2=9%).Conclusions:This meta-analysis indicates that nocturnal blood pressure(including systolic blood pressure and diastolic blood pressure)was statistically significantly reduced in NTG eyes compared with normal controls.It is indicated that nocturnal hypotension may be an important risk factor for the development of normal-tension glaucoma.It provides an extremely pregnant idea and method for clinical diagnosis,precaution and treatment of normal-tension glaucoma patients.