心脏移植术后患者新发糖尿病危险因素的Meta分析

Risk factors of new-onset diabetes mellitus after heart transplantation:a Meta-analysis

目的系统评价心脏移植术后患者新发糖尿病的危险因素,为临床防治心脏移植术后新发糖尿病提供依据。方法计算机检索PubMed、Embase、Cochrane、Web of Science、CINAHL、中国知网、万方数据库、中国生物医学文献数据库和维普数据库,检索时间均为建库至2020年9月,收集心脏移植术后新发糖尿病危险因素的观察性研究。由2名研究者提取资料并进行偏倚风险评价,用RevMan5.3软件进行Meta分析。结果共纳入14项研究9808例研究对象,心脏移植术后新发糖尿病总发病率为20.22%(1983/9808)。Meta分析结果显示,不可干预的危险因素有年龄、糖尿病家族史(OR=1.21、2.15,均P<0.01);可干预的危险因素有体重指数、术前空腹血糖、使用他克莫司、使用类固醇、冷缺血时间(OR=1.08~5.13,P≤0.01)。结论心脏移植术后新发糖尿病受较多因素影响,医护人员应识别其危险因素,采取针对性干预措施,提高治疗效果与移植成功率。

Objective To systematically review the risk factors of new-onset diabetes mellitus(NODM)after heart transplantation,and to provide reference for clinical prevention and treatment of NODM.Methods Such databases as PubMed,Embase,Cochrane,Web of Science,CINAHL,CNKI,WanFang Data,SinoMed and VIP were searched from inception to September 2020 to collect observational studies on risk factors of NODM after heart transplantation.According to the inclusion and exclusion criteria,two reviewers independently screened the literature,extracted data and assessed the risk of bias of included studies.Then Meta-analysis was performed using RevMan 5.3 software.Results A total of 14 studies involving 9808 participants were included.the incidence of NODM was 20.22%(1983/9808).The results of Meta-analysis indicated that non-modifiable risk factors of NODM included age(OR=1.21,P<0.01),family history of diabetes(OR=2.15,P<0.01),while modifiable risk factors included BMI,higher FPG before transplantation,tacrolimus usage,steroids usage,cold ischemic time(OR=1.08-5.13,P≤0.01).Conclusion NODM after heart transplantation are subjected to multiple factors.Medical staff should identify the risk factors,and take targeted mea-sures,in an effort to improve treatment effect and success rate of heart transplantation.