肺癌合并糖尿病患者放射性肺炎相关性的Meta分析

Meta-analysis of the correlation between lung cancer and diabetes patients with radiation pneumonitis

目的:通过Meta分析综合评价肺癌合并糖尿病与放射性肺炎发生率及分级的相关性。方法:注册试验:向PROSPERO(International prospective register of systematic reviews)提交研究计划并申请注册码。制定检索策略,检索从建库至2020年1月1日公开发表在Embase、PubMed、Web of science、Cochrane Library、Clinical Trails、万方医学网、中国知识基础设施工程(CNKI)、中国生物医学文献(CBM)和维普中文科技期刊数据库等数据库中肺癌合并糖尿病(病例组)、肺癌未合并糖尿病(对照组)发生放射性肺炎患者,通过纳入和排出标准筛选文献并提取资料,根据纽卡斯尔-渥太华量表(the Newcastle-Ottawa Scale,NOS)评价纳入资料的质量,采用Review Manager 5.3软件进行系统分析。结果:在PROSPERO上注册并审核通过(注册号为:CRD42020156228)。最终纳入24篇病例对照研究(Case-control study,CCS),共3718例肺癌。病例组放射性肺炎发生率41.79%,显著高于对照组18.40%(P<0.001);病例组中一、二、三级放射性肺炎发生率分别为17.65%、25.1%、7.98%,明显高于对照组的4.55%、12%、4.67%(P<0.05);血糖控制较好的患者放射性肺炎发生率低于血糖控制较差的患者(29.44%VS 55.05%);4级放射性肺炎、糖尿病病程长短与放射性肺炎的关系差异无统计学意义(P>0.05)。结论:糖尿病是肺癌患者发生放射性肺炎的易感因素,为肺癌患者防治放射性肺炎提供有效的临床依据和参考价值。

Objective To comprehensively evaluate the correlation between the incidence of lung cancer with diabetes and radiation pneumonia and grade through Meta analysis.Method Registration trial:Submit a research plan to PROSPERO(International prospective register of systematic reviews)and apply for a registration code.Formulate a search strategy to search publicly published in Embase,PubMed,Web of Science,Cochrane Library,Clinical Trails,Wanfang Medical Network,China Knowledge Infrastructure Engineering(CNKI),China Biomedical Literature(CBM)and Weipu Chinese Science and Technology Journal Database and other databases in patients with lung cancer with diabetes(case group)and lung cancer without diabetes(control group)who developed radiation pneumonia(from the establishment of the database to January 2020),through the inclusion and exclusion criteria,screening literature and extracting data,according to the Newcastle-Ottawa scale(The Newcastle-Ottawa Scale,NOS)to evaluate the quality of the included data,using Review Manager 5.3 software for system analysis.Results Registered and approved on PROSPERO(registration number:CRD42020156228).Finally,24 case-control studies(CCS)were included,including 3718 cases of lung cancer.The incidence rate of radiation pneumonitis in the case group was 41.79%,significantly higher than that in the control group 18.40%(P<0.001);the incidence rates of radiation pneumonia in the first,second,and third cases in the case group were 17.65%,25.1%,and 7.98%,respectively,which were significantly higher than the control group 4.55%,12%,4.67%of the group(P<0.05);the incidence of radiation pneumonitis in patients with better blood glucose control was lower than that in patients with poor blood glucose control(29.44%vs 55.05%);The relationship with of the duration of grade 4 radiation pneumonia,duration sof diabetes and radiation pneumonitis was not statistically significant(P>0.05).Conclusion Diabetes is a susceptible factor for radiation pneumonitis in lung cancer patients,and it provides an effective clinical basis and reference value for lung cancer patients to prevent and treat radiation pneumonitis.