衰弱与直立性低血压发生风险关系的Meta分析

Frailty and the risk of orthostatic hypotension:a meta-analysis

目的系统评价衰弱和直立性低血压发生风险的关系。方法计算机检索PubMed、EMbase、Web of Science、CBM、CNKI、VIP和WanFang Data数据库,搜集国内外关于衰弱和直立性低血压发生关系的相关性研究,检索时限均从建库至2020年7月7日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入5个研究,包括8671例患者。Meta分析结果显示:与非衰弱组相比,衰弱前期[OR=1.04,95%CI=(0.99,1.09),P=0.11]和衰弱[OR=1.02,95%CI=(0.92,1.13),P=0.70]不会增加直立性低血压的患病风险。亚组分析结果显示:采用不同的衰弱评估工具(Fried量表、临床衰弱量表和衰弱指数),不同样本量大小(<500例或者≥500例),不同地区(欧洲、亚洲和美洲),研究对象的不同来源(医院和社区),衰弱均不会增加直立性低血压患病风险。结论当前证据显示,衰弱不会增加直立性低血压的患病风险。受纳入研究数量和质量的限制,上述结论尚需更多高质量研究予以验证。

Objective To systematically review the relationship between frailty and risk of orthostatic hypotension.Methods PubMed,EMbase,Web of Science,CNKI,CBM,VIP and WanFang Data databases were electronically searched to collect studies on the association between frailty and orthostatic hypotension from inception to July 7 th,2020.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies.Meta-analysis was then performed by RevMan 5.3 software.Results Five cross-sectional studies involving 8671 patients were included.The results of meta-analysis showed that prefrailty(OR=1.04,95%CI 0.99 to 1.09,P=0.11)and frailty(OR=1.02,95%CI=0.92 to 1.13,P=0.70)were not associated with orthostatic hypotension.The results of subgroup analysis showed that differences of sample size(<500 or≥500),using different frailty assessment tools(Fried scale,clinical frailty scale,and frailty index),different regions(Europe,Asia,and America)and different sources of studied subjects(hospitals and communities),the risk of orthostatic hypotension were not increased with frailty.Conclusions Current evidence shows that frailty does not increase the risk of orthostatic hypotension.Due to limited quality and quantity of included studies,the above conclusions are needed to be validated by more high-quality studies.