糖尿病患者衰弱危险因素的Meta分析

目的 通过Meta分析明确糖尿病患者衰弱的危险因素,为有效预防糖尿病患者衰弱提供科学依据。方法 计算机检索中国知网、维普、中国生物医学文献数据库、万方、PubMed、Web of Science、Cochrane Library,收集关于糖尿病患者衰弱影响因素的横断面研究、病例对照研究或队列研究,检索时限为自建库至2021年3月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 共纳入21篇文献,其中14篇横断面研究,4篇队列研究,3篇病例对照研究,糖尿病患者合计6 937例,其中衰弱患者1 562例（22.5%）,涉及影响因素13个。Meta分析结果显示,糖尿病患者衰弱的危险因素为高龄（OR=1.29,95%CI：1.12~1.49）、女性（OR=2.68,95%CI：1.88~3.81）、文化程度较低（OR=2.30,95%CI：1.55~3.42）、糖化血红蛋白水平较高（OR=1.92,95%CI：1.33~2.77）、合并其他疾病（OR=2.35,95%CI：1.49~3.73）、住院次数多（OR=7.28,95%CI：3.56~14.89）、营养状况较差（OR=3.13,95%CI：1.96~4.99）、日常生活活动能力较低（OR=2.74,95%CI：1.98~3.80）和抑郁（OR=1.78,95%CI：1.32~2.41）,而体质量（OR=1.48,95%CI：0.30~7.42）和饮酒（OR=2.12,95%CI：0.67~6.76）与糖尿病患者衰弱无关,运动（OR=0.85,95%CI：0.74~0.97）和25-羟基维生素D₃（OR=0.94,95%CI：0.90~0.98）为糖尿病患者衰弱的保护因素。敏感性分析与发表偏倚结果显示各因素合并结果较稳定,发表偏倚不明显。结论 糖尿病患者的衰弱与多种因素有关,其危险强度由高到低依次为住院次数多、营养状况较差、日常生活活动能力较差、女性、合并其他疾病、文化程度较低、糖化血红蛋白水平较高、抑郁以及高龄。

Meta-analysis of Risk Factors for Frailty in Diabetic Patients

Objective To explore the risk factors of frailty in diabetic patients by meta-analysis and to provide reference for its prevention and treatment. Methods We retrieved China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Database (VIP), Chinese Biomedical Literature Data- base (CBM), Wanfang Database, PubMed, Web of Science, and Cochrane Library from the inception to March 2021 to collect studies on factors associated with frailty in patients with diabetes. Two researchers independently screened the literature, extracted the data and evaluated the risk of bias of the included studies. A meta-analysis on the included literature was performed by using RevMan 5.3. Results Totally 21 articles with 6,937 diabetic patients were included, including 14 cross-sectional studies, 4 cohort studies, and 3 case-control studies. There were 1,562 patients with frailty (22.5%), involving 13 influencing factors. Meta-analysis showed that risk factors of diabetic patients were advanced age (OR=1.29, 95%CI:1.12~1.49), female (OR=2.68, 95%CI:1.88~3.81), less educated (OR=2.30, 95%CI:1.55~3.42), high glycosylated hemoglobin level (OR=1.92, 95%CI: 1.33~2.77), combined other diseases (OR=2.35, 95%CI:1.49~3.73), more hospitalizations (OR=7.28, 95%CI:3.56~14.89), poor nutritional status（OR=3.13, 95%CI：1.96~4.99）, lower activities of daily living（OR=2.74, 95%CI:1.98~3.80） and depression (OR=1.78, 95%CI:1.32~2.41). Weight (OR=1.48, 95%CI:0.30~7.42) and alcohol consumption (OR=2.12, 95%CI:0.67~6.76) were not associated with frailty in diabetic patients. Exercise (OR=0.85, 95%CI:0.74~0.97) and 25 (OH) D₃ (OR=0.94, 95%CI:0.90~0.98) were protective factor for frailty in diabetic patients. Sensitivity analysis and publication bias test indicated that there was no publication bias for case-control studies and the results of the meta-analysis were stable. Conclusion The occurrence of frailty in diabetic patients is related to various risk factors, and factors with risk intensity ranging from high to low are more hospitalizations, poor nutritional status, lower activities of daily living, female, combined other diseases, less educated, higher glycosylated hemoglobin level, depression,and advanced age.