中国2型糖尿病人群合并骨质疏松症危险因素的Meta分析

Risk Factors for Type 2 Diabetic Osteoporosis in Chinese Population:A Meta-analysis

目的通过Meta分析整合相关文献,全面评估中国2型糖尿病人群合并骨质疏松症发病的危险因素,以帮助了解该病的发病机制,降低发病率,改善疾病预后。方法计算机检索中国知网、万方数据库、维普中文期刊数据库、中国生物医学文献数据库、Pubmed、Embase、Web of Science、Cochrane Library等8个数据库自建库至2020年7月15日的文献。运用纽卡斯尔-渥太华量表(New castle-Ottawa quality assement scale,NOS)对纳入的文献进行质量评价。采用Stata15.0和Revman5.3软件进行数据统计分析。结果共检索出622篇文献,确定纳入12篇文献,均为病例对照研究。文献质量评价得分均≥6分。Meta分析结果显示:高龄(OR=1.998,95%CI:1.632~2.445)、女性(OR=2.973,95%CI:1.678~5.268)、糖尿病病程长(OR=1.726,95%CI:1.276~2.335)、高糖化血红蛋白(OR=1.795,95%CI:1.417~2.274)、高空腹血糖(OR=2.320,95%CI:1.795~2.999)、低体重指数(OR=1.243,95%CI:1.015~1.523)、低胰岛素水平(OR=1.909,95%CI:1.162~3.137)、低胰岛素样生长因子-1(OR=1.034,95%CI:1.007~1.062)是该病的危险因素。25-羟维生素D与该病的关系有待进一步研究。此外,敏感性分析及偏倚检验表明,该研究结果是可靠且稳定的。通过绘制漏斗图及Egger检验发现,糖化血红蛋白(P=0.015)、空腹血糖(P=0.036)存在发表偏倚。结论高龄、女性、糖尿病病程长、高糖化血红蛋白、高空腹血糖、低体重指数、低胰岛素水平、低胰岛素样生长因子-1是中国2型糖尿病人群合并骨质疏松症的危险因素。

Objective Through meta-analysis and integration of relevant literature,a comprehensive assessment of the risk factors of type 2 diabetic osteoporosis in Chinese population was performed to help understand the pathogenesis of the disease,reduce the incidence,and improve the prognosis of the disease.Methods Articles were searched from 8 databases including China National Knowledge Infrastructure(CNKI),Wanfang,VIP,China Biomedical literature Database(CBM),PubMed,Embase,Web of Science,and Cochrane Library from inception to July 15,2020.The Newcastle-Ottawa quality assessment scale(NOS)was used to evaluate the quality of the included literature.Data statistical analysis was performed by using Stata15.0 and Revman5.3 software.Results A total of 622 articles were retrieved and 12 articles were determined to be included,all of which were case-control studies.Literature quality evaluation scores were≥6 points.Meta-analysis showed that advanced age(OR=1.998,95%CI:1.632-2.445),female(OR=2.973,95%CI:1.678-5.268),long course of diabetes(OR=1.726,95%CI:1.276-2.335),high glycosylated hemoglobin(OR=1.795,95%CI:1.417-2.274)and fasting plasma glucose(OR=2.320,95%CI:1.795-2.999),low body mass index(OR=1.243,95%CI:1.015-1.523),insulin level(OR=1.909,95%CI:1.162-3.137),insulin-like growth factor-1(OR=1.034,95%CI:1.007-1.062)were risk factors for the disease.The relationship between 25-hydroxy vitamin D and the disease needed further study.In addition,the sensitivity analysis and bias tests showed that the results of this study were reliable and stable.Through drawing a funnel chart and egger test,it was found that glycosylated hemoglobin(P=0.015)and fasting plasma glucose(P=0.036)had publication bias.Conclusion Advanced age,female,long course of diabetes,high glycosylated hemoglobin and fasting plasma glucose,low body mass index and insulin level and insulin-like growth factor-1 were risk factors for type 2 diabetic osteoporosis in Chinese population.