Abstract
石舒原,周庆欣,孙宏玉,詹思延,孙凤,张淑燕.糖尿病视网膜病变可变风险因素证据图谱构建[J].Chinese journal of Epidemiology,2024,45(12):1736-1744
糖尿病视网膜病变可变风险因素证据图谱构建
Construction of evidence graph for modifiable risk factors for diabetic retinopathy
Received:April 25, 2024  
DOI：10.3760/cma.j.cn112338-20240425-00217
KeyWord: 糖尿病视网膜病变  风险因素  伞状综述  证据分级
English Key Word: Diabetic retinopathy  Risk factors  Umbrella review  Classification of evidence
FundProject:中国康复科学所中央级公益性科研院所基本科研业务费项目(CRSI2023CZ-11);国家自然科学基金(72074011);北京市自然科学基金-海淀原始创新联合基金前沿项目(L222103)
Author NameAffiliationE-mail
Shi Shuyuan Department of Disability Prevention Research, China Rehabilitation Science Institute, Beijing 100068, China  
Zhou Qingxin Institute of Non-communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin 300011, China  
Sun Hongyu Department of Nursing Humanities Teaching and Research, School of Nursing, Peking University, Beijing 100191, China  
Zhan Siyan Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China 		 
Sun Feng Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China  
Zhang Shuyan Department of Disability Prevention Research, China Rehabilitation Science Institute, Beijing 100068, China zsy0227@126.com 
Hits: 212
Download times: 50
Abstract:
      目的 糖尿病视网膜病变（DR）是导致成年人致盲的主要原因，与患者生活质量低下和残疾负担加重密切相关。本文旨在总结DR相关可变风险因素的可用证据。方法 在PubMed、Cochrane Library、中国知网、万方数据知识服务平台中检索截至2023年6月有关DR可变风险因素的Meta分析，并对其进行汇总分析。对于每组关联，使用R 4.3.2软件计算其效应值及其95%CI、异质性、小研究效应、过量显著性偏倚和95%预测区间，并对证据的可信度和方法学质量进行评估分级。结果 共纳入23个Meta分析，涵盖药物使用、合并症、日常干预、生物标志物、生活方式和身体测量指标等72组关联结果。其中，糖化血红蛋白变异性大（RR=1.45，95%CI：1.26~1.66）、尿微量白蛋白阳性（OR=2.44，95%CI：1.99~2.97）具有令人信服（Ⅰ级）的证据强度，胰岛素使用（RR=3.48，95%CI：2.14~5.67）具有高度提示性（Ⅱ级）的证据强度。此外，合并高血压（OR=2.03，95%CI：1.06~3.97）、血糖控制不良（OR=4.35，95%CI：1.47~12.85）、大量白蛋白尿阳性（OR=8.42，95%CI：3.52~20.15）、长时间睡眠（OR=2.05，95%CI：1.37~3.05）、维生素D缺乏（OR=2.02，95%CI：1.17~3.50）、牙周炎（OR=4.51，95%CI：1.76~11.55）是DR的主要危险因素。强化血压控制（RR=0.78，95%CI：0.65~0.94）、饮食控制（OR=0.64，95%CI：0.47~0.89）、中强度体育运动（RR=0.76，95%CI：0.59~0.97）是DR的主要保护因素。结论 强化血糖和血压控制、保持健康生活方式可以显著降低糖尿病患者发生DR的风险，研究证据可以用于确定高危人群、推荐合理治疗方案和健康生活干预措施。
English Abstract:
      Objective Diabetic retinopathy (DR) has been reported as the leading cause of blindness among diabetic adults, which is closely related to poor quality of life and increased burden of disability. This study aimed to aggregate the optimally available evidence on modifiable risks of DR. Methods Until June 2023, PubMed, Cochrane Library, CNKI, and Wanfang databases were used to retrieve Meta-analysis about various risk factors for DR, and Meta-analysis were analyzed and summarized. R 4.3.2 software was used for each Meta-analytic association to calculate the effect size, 95%CI, heterogeneity, small-study effects, excess significance bias, and 95% prediction intervals. The credibility of significant evidence was graded. Results We captured 23 eligible papers (72 associations) covering a wide range of medication use, concomitant diseases, daily intervention, biomarkers, lifestyle, and physical measurement index. Among them, higher HbA1c variability (RR=1.45, 95%CI: 1.26-1.66) and urine microalbumin positive (OR=2.44, 95%CI: 1.99-2.97) were convincing (grade Ⅰ) evidence, and insulin use (RR=3.48, 95%CI: 2.14-5.67) was highly suggestive (grade Ⅱ) evidence. Moreover, hypertension (OR=2.03, 95%CI: 1.06-3.97), poor glycemic control (OR=4.35, 95%CI: 1.47-12.85), positive macroalbuminuria (OR=8.42, 95%CI: 3.52-20.15), long sleep duration (OR=2.05, 95%CI: 1.37-3.05), vitamin D deficiency (OR=2.02, 95%CI: 1.17-3.50), periodontitis (OR=4.51, 95%CI: 1.76-11.55) were the main risk factors for DR. Intensive blood pressure intervention (RR=0.78, 95%CI: 0.65-0.94), dietary control (OR=0.64, 95%CI: 0.47-0.89) and moderate intensity physical activity (RR=0.76, 95%CI: 0.59-0.97) yielded significant protective associations with DR. Conclusions Intensive blood pressure glycemic control, and a healthy lifestyle pattern could reduce the risk of DR. This study provides the evidence to identify high-risk populations and recommends rational treatment options and healthy living interventions.
View Fulltext   Html FullText     View/Add Comment  Download reader
Close


Copyright：Editorial Department, Chinese journal of Epidemiology
Address：No. B115 National Institute for Communicable Disease Control and Prevention,
     No.155 Changbai Road, Changping District, Beijing 102206, P.R.China.
Tel (Fax):010-58900730
Email：zhlxb1981@sina.com
Technical support：E-Tiller