中医体质类型与糖尿病前期相关性研究的系统评价及Meta分析

Systematic Review and Meta-analysis on the Correlations between TCM Constitutions and Prediabetes

目的:探讨糖尿病前期中医体质分布规律,确定该病常见的高危体质类型,为今后的临床和科学研究提供循证证据。方法:检索国家知识基础设施数据库(CNKI)、中国生物医学文献数据库(CBM)、中国学术期刊数据库(CSPD)及中文科技期刊数据库(CCD)、PubMed、Embase、Cochrane Library、Web of Science数据库,纳入所有评价糖尿病前期与中医体质的相关性的临床研究文献。采用Strata 14.0软件进行横断面研究的单个率的Meta分析,Review Manager 5.3软件进行病例对照研究的Meta分析,用比值比(OR)和95%置信区间(CI)描述效应值。2位独立的评价者对纳入研究的方法学质量进行评估。结果:共纳入41项研究,样本量总计9611例。痰湿质、平和质、阴虚质、气虚质分别占糖尿病前期人群的22%(18%~25%)、17%(13%~20%)、16%(13%~19%)和11%(11%~15%)。病例对照研究的Meta分析显示,痰湿质、阴虚质人群糖尿病前期发病风险的OR值分别是2.86(1.84~4.45)和2.33(1.48~3.68)。糖尿病前期人群在不同地区、年龄、性别方面,中医体质类型分布差异有统计学意义(P<0.05)。结论:痰湿质、平和质、阴虚质、气虚质是糖尿病前期人群最常见的体质,其中痰湿质、阴虚质可能是糖尿病前期发病的危险因素,平和质可能是糖尿病前期的保护因素。

Objective:To investigate the distribution law of TCM constitutions in the patients with prediabetes and identify the common high-risk constitutions of prediabetes,so as to provide evidence for the future clinical practice and scientific research.Methods:The China National Knowledge Infrastructure(CNKI),China Biology Medicine(CBM),China Science Periodical Database(CSPD),Chinese Citation Database(CCD),PubMed,Embase,Cochrane Library,and Web of Science were searched for the articles about the clinical trials assessing the correlations between prediabetes and TCM constitutions.Strata 14.0 was used for meta-analysis of single rates in cross-sectional studies,and Review Manager 5.3 software was used for meta-analysis of case-control studies.The odds ratio(OR)and 95%confidence interval(CI)were used to describe effect sizes.Two independent reviewers assessed the methodological quality of the included studies.Results:A total of 41 studies were included,with a total sample size of 9611 patients.Among the patients with prediabetes,those with phlegm-dampness,plain,yin deficiency,and qi deficiency constitutions accounted for 22%(18%to 25%),17%(13%to 20%),16%(13%to 19%),and 11%(11%to 15%),respectively.The meta-analysis of the case-control studies showed that the OR values of the risk of prediabetes in the people with phlegm-dampness and yin-deficiency constitutions were 2.86(1.84 to 4.45)and 2.33(1.48 to 3.68),respectively.The distribution of TCM constitutions showcased significant differences in terms of different regions,ages,and genders(P<0.05).Conclusion:Phlegm-dampness,plain,yin deficiency,and qi deficiency were the common TCM constitutions of the patients with prediabetes.Phlegm-dampness and yin deficiency constitutions may be the risk factors of prediabetes,and the plain constitution may be a protective factor of prediabetes.