新型冠状病毒肺炎合并糖尿病患者临床特点的Meta分析

Meta analysis of clinical characteristics of patients of novel coronavirus pneumonia combined with diabetes mellitus

目的 系统评价新型冠状病毒肺炎合并糖尿病患者的临床特点,为临床提供循证依据。方法 系统检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、Embase、The cochrane library等中英文数据库,收集2019年1月至2022年3月新型冠状病毒肺炎合并糖尿病的相关文献。对纳入的研究使用NOS评分量表进行质量评价,应用Rev Man 5.4软件对数据进行Meta分析。结果 符合纳入标准的文献共11篇,新型冠状病毒肺炎患者病例共2 468例,根据是否合并糖尿病分为糖尿病组910例,非糖尿组1 558例。Meta分析结果显示:糖尿病组的重症及危重症患者比例(OR=3.77,95%CI:2.55~5.58)、死亡率(OR=3.43,95%CI:2.48~4.74)均高于非糖尿病组(P<0.01),病程长于非糖尿病组(MD=2.71,95%CI:0.68~4.74,P<0.01);糖尿病组白细胞数高于非糖尿病组(MD=0.31,95%CI:0.03~0.59,P=0.03),淋巴细胞数低于非糖尿病组(MD=-0.22,95%CI:-0.40~-0.04,P=0.02),两组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、血肌酐及C反应蛋白差异均无统计学意义(P值均>0.05)。结论 新型冠状病毒肺炎合并糖尿病患者较未合并糖尿病患者的免疫系统损害更大、病情更重、病程更长、死亡风险更高,应加强对此类患者的监护,积极治疗以改善预后。

Objective To systematically evaluate the clinical characteristics of patients of novel coronavirus pneumonia(COVID-19)combined with diabetes mellitus;to provide evidence-based basis for clinical treatment. Methods The literature databases in Chinese or English such as China National Knowledge Infrastructure(CNKI),Wanfang database, VIP database China biomedical literature database, PubMed, Web of Science, Embase, the cochrane library were searched for papers about Coronavirus disease 2019(COVID-19) combined with diabetes mellitus from Jan 2019 to Mar 2022.The quality of the included studies was evaluated by NOS scoring scale, and the data were subjected to meta analysis using Rev Man 5.4 software. Results There were 11 literatures met the inclusion criteria, with 2 468 reported patients with novel coronavirus pneumonia, who were divided into diabetic group(910 patients) and non-diabetic group(1 558 patients).The meta-analysis showed that the proportions of patients with severe or critical conditions(OR=3.77,95%CI:2.55-5.58)and death rate(OR=3.43,95%CI:2.48-4.74) were all significantly higher in diabetic group than those in non-diabetic group(all P<0.01).Compared with non-diabetic group, the diabetic group had longer disease course(MD=2.71,95%CI:0.68-4.74,P<0.01),higher white blood cell count.The lymphocyte count(MD=0.31,95%CI:0.03-0.59,P=0.03) and lower lymphocyte count(MD=-0.22,95%CI:-0.40--0.04,P=0.02).The differences of alanine aminotransferase, aspartate aminotransferase, serum creatinine and C-creative protein levels were not statistically significant between 2 groups(all P>0.05). Conclusion Patients with COVID-19 combined with diabetes mellitus suffer with greater damage to their immune system, demonstrating more severe conditions, longer disease course and higher death risk than COVID-19 patients without diabetes.The monitoring of COVID-19 combined with diabetes mellitus patients should be strengthened, more active treatment should be applied to improve prognosis.