心血管代谢性共病危险因素的Meta分析

Risk factors for cardiometabolic multimorbidity:a meta-analysis

目的系统评价心血管代谢性共病(CMM)的危险因素,为制定CMM防治策略提供循证依据。方法检索中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普中文科技期刊数据库、PubMed和Cochrane Library等数据库,收集从建库至2023年3月20日发表的关于CMM危险因素的文献;采用RevMan 5.4软件和Stata16.0软件进行Meta分析;采用逐一剔除单个研究进行敏感性分析;采用Egger检验评估发表偏倚。结果初期检索获得494篇文献,最终纳入20篇,其中队列研究13篇,样本量约194万人;横断面研究7篇,样本量约1300万人。Meta分析结果显示,女性(OR=1.54,95%CI:1.40~1.71)、中年(OR=3.80,95%CI:3.33~4.34)、老年(OR=2.82,95%CI:1.48~5.37)、城市居住(OR=1.41,95%CI:1.27~1.57)、受教育程度较高(OR=2.01,95%CI:1.35~3.01)、经济水平较高(OR=1.21,95%CI:1.16~1.25)、超重(OR=1.92,95%CI:1.64~2.26)、肥胖(OR=3.01,95%CI:2.30~3.93)、中心性肥胖(OR=1.70,95%CI:1.12~2.56)、吸烟(OR=1.27,95%CI:1.07~1.51)、饮酒(OR=1.27,95%CI:1.01~1.59)、饮食不规律(OR=1.10,95%CI:1.02~1.18)、蔬菜水果摄入不足(OR=1.12,95%CI:1.07~1.17)、夜间睡眠不足(OR=1.17,95%CI:1.08~1.27)和抑郁(OR=1.50,95%CI:1.33~1.69)是CMM的危险因素。中心性肥胖和饮酒的敏感性分析结果不稳健。Egger检验显示无明显发表偏倚。结论女性、中年、老年、城市居住、受教育程度较高、经济水平较高、超重、肥胖、中心性肥胖、吸烟、饮酒、饮食不规律、蔬菜水果摄入不足、夜间睡眠不足和抑郁是CMM的危险因素。

Objective To systematically evaluate risk factors for cardiometabolic multimorbidity(CMM),so as to provide the evidence for formulating CMM prevention and control strategies.Methods Publications pertaining to the risk factors for CMM were retrieved from databases,including SinoMed,CNKI,Wanfang Data,VIP,PubMed and Cochrane Library from inception to March 31,2023.Meta-analysis was performed using the software RevMan 5.4 and Stata 16.0,and sensitivity analysis was performed using the leave-one-out method.The publication bias was evaluated using Egger's test.Results Totally 494 publications were screened,and 20 publications were included in the final analysis,including 13 cohort studies(covering 1940000 participants)and 7 cross-sectional studies(covering 13000000 participants).Meta-analysis revealed that female(OR=1.54,95%CI:1.40-1.71),middle age(OR=3.80,95%CI:3.33-4.34),elderly(OR=2.82,95%CI:1.48-5.37),urban resident(OR=1.41,95%CI:1.27-1.57),higher education level(OR=2.01,95%CI:1.35-3.01),higher economic level(OR=1.21,95%CI:1.16-1.25),overweight(OR=1.92,95%CI:1.64-2.26),obesity(OR=3.01,95%CI:2.30-3.93),central obesity(OR=1.70,95%CI:1.12-2.56),smoking(OR=1.27,95%CI:1.07-1.51),alcohol con⁃sumption(OR=1.27,95%CI:1.01-1.59),irregular diet(OR=1.10,95%CI:1.02-1.18),insufficient intake of vegetables and fruits(OR=1.12,95%CI:1.07-1.17),lack of sleep at night(OR=1.17,95%CI:1.08-1.27),and depression(OR=1.50,95%CI:1.33-1.69)were risk factors for CMM.Sensitivity analysis of effects of central obesity and alcohol consumption were not robust.No publication bias was examined by Egger's test.Conclusion Female,middle age,elderly,urban resi⁃dent,higher education level,higher economic level,overweight,obesity,central obesity,smoking,alcohol consumption,ir⁃regular diet,insufficient intake of vegetables and fruits,lack of sleep at night and depression are risk factors for CMM.