持续气道正压通气治疗对阻塞性睡眠呼吸暂停综合征合并2型糖尿病影响的荟萃分析

发布时间：2018-03-12 06:55

本文选题：2型糖尿病　切入点：阻塞性睡眠呼吸暂停综合征　出处：《大连医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：阻塞性睡眠呼吸暂停综合征（OSAS）在成年人群中是一种常见的疾病。OSAS患者中血糖代谢紊乱更常见，提示OSAS可能会加剧糖尿病患者的血糖代谢紊乱状态。连续气道正压通气（CPAP）是OSAS治疗的首选方式，也有可能对糖尿病患者血糖代谢有帮助。为此，我们选取已发表的随机对照试验进行荟萃分析，系统评估CPAP对OSAS合并2型糖尿病（T2DM）患者在血糖控制等方面的影响。方法：我们搜索了PubMed、EMBASE数据库，中文的维普及CNKI数据库。从建库直到2013年3月，检索所有发表的关于OSAS和T2DM关系的研究，选取CPAP对T2DM患者的代谢方面影响的随机对照试验。入选标准：（1）公开发表的中英文文献，数据资料完整；（2）研究OSAS合并T2DM成年患者，，没有种族、性别限制；（3）随机对照试验，不考虑分配隐藏或盲法；（4）干预措施：CPAP治疗作为治疗组，非特异治疗作为对照组；（5）评价结果：糖化血红蛋白（HbA1c）、空腹血糖(FBG)、餐后血糖（PBG）、胰岛素抵抗指数(HOMA-IR)、体重指数(BMI)和其他代谢指标，以及睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSPO2)、爱普沃斯嗜睡量表评分(ESS)等呼吸相关指标也包括在内。排除标准：仅以摘要发表、非随机对照研究、以及重复发表或未公开发表、数据不全的文献。进行初步筛选，两名研究者独自阅读所检索到文献的题目和摘要，分别根据入选及剔除标准选择合格的文献，采用统一的表格提取资料，利用Google和其他搜索引擎在互联网上查找相关的文献。对于缺乏的数据，通过电子邮件与作者取得联系。收集的信息包括作者的姓名，出版年份，研究地区和研究人群，干预措施，两组患者的基本特征，研究时间和效应指标等。英文文献以HbA1c，BMI，ESS的均值和标准差作为效应指标。中文文献以HbA1c，FBG，PBG，HOMA-IR，BMI，ESS，AHI，LSPO2的均值和标准差作为效应指标。对最终纳入的中英文文献，使用JADAD量表进行质量评价。采用Review Manager5.1软件进行荟萃分析。中英文荟萃结果分别列出。结果：共查询了586篇相关研究，排除文献包括51篇重复和未公开发表，19篇干预措施不符合，76篇数据不全，118篇仅以摘要发表，297篇非随机对照试验。选取了17篇流行病学调查相关研究参与进行系统回顾。共纳入8篇随机对照试验进行荟萃分析，包括330例OSAS合并T2DM患者。3篇英文研究荟萃结果分析显示：CPAP治疗后改善了ESS情况，[WMD=-6.33，95%CI：（-9.01，-3.66），P0.00001]，差异有统计学意义。对HbA1c水平[WMD=-0.12，95%CI：（-0.86，0.62），P=0.75]及BMI[WMD=-0.62，95%CI：（-2.40，1.16），P=0.49]方面的影响，虽然可见似乎略有下降，但以治疗前后差值作比较，效应量无统计学意义。5篇中文研究的荟萃分析显示：CPAP治疗组与对照组在HbA1c[WMD=-0.50，95%CI：（-0.72，-0.28），P0.00001]、 FBG[WMD=-1.19，95%CI：（-1.52，-0.87）， P0.00001]、PBG[WMD=-1.02，95%CI：（-1.43，-0.62），P0.00001]方面的差异有统计学意义；在HOMA-IR[WMD=-1.80，95%CI：（-4.64，1.04），P=0.21]、BMI[WMD=-0.69，95%CI：（-1.79，0.41）， P=0.22]方面差异无统计学意义。 CPAP可提高LSPO2[WMD=24.04，95%CI：（20.04，28.05），P0.00001]，但对患者的AHI无改善[WMD=-23.65，95%CI：（-51.24，3.93），P=0.09]。结论：对于合并OSAS的T2DM患者，CPAP治疗改善LSPO2及血糖控制，但仍需要大规模的研究进一步证实。
[Abstract]:Objective: obstructive sleep apnea syndrome (OSAS) in adults is a common disease of glucose metabolism in patients with.OSAS disorders are more common, suggesting that OSAS may exacerbate the disorder of glucose metabolism in diabetic patients. Continuous positive airway pressure (CPAP) is the preferred way to OSAS treatment, there may be help on glucose metabolism in diabetic patients. Therefore, we selected randomized controlled trials published meta-analysis, CPAP system evaluation of OSAS patients with type 2 diabetes mellitus (T2DM) patients in control of blood sugar.
Methods: We searched the PubMed EMBASE database, the CNKI database and VIP Chinese. From inception until March 2013, all published on OSAS and T2DM to study the relationship between the retrieval of randomized controlled trials to select the metabolism of CPAP in patients with T2DM. The influence of inclusion criteria: (1) published in the English literature data; (2) study of OSAS combined T2DM adult patients, there is no racial, gender restrictions; (3) randomized controlled trials, regardless of allocation concealment or blind method; (4) intervention: CPAP treatment as treatment group and non specific treatment as the control group; (5) evaluation results: glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PBG), insulin resistance index (HOMA-IR), body mass index (BMI) and other metabolic indexes, and sleep apnea hypopnea index (AHI), the lowest oxygen saturation (LSPO2), SAP Voss sleepiness score (ES S) respiratory related indicators are also included. Exclusion criteria: published only in abstract, non randomized studies, and repeated published or unpublished literature, incomplete data. Preliminary screening, two researchers reading alone retrieved literature titles and abstracts, respectively according to the inclusion and exclusion criteria to select qualified the literature, form a unified data extraction, using Google and other search engines on the Internet to find relevant documents. For the lack of data, contact by email with the author. The collected information including the author's name, year of publication, research area and intervention study population, the basic characteristics of the two groups of patients. Study on time and effect index. English literature by HbA1c, BMI, ESS mean and standard deviation as the effect indicators. Chinese literature by HbA1c, FBG, PBG, HOMA-IR, BMI, ESS, AHI, mean and standard LSPO2 JADAD Review was used to evaluate the quality of the final Chinese and English literatures. Meta analysis was conducted by using Manager5.1 software.
Results: a total of 586 query related studies, including 51 articles excluded studies repeated and unpublished, 19 intervention measures do not meet, 76 incomplete data, 118 articles published 297 articles only in the abstract, non randomized controlled trials. Selects 17 pieces of epidemiological investigation involved in related research system were included in the review. 8 randomized controlled trials for meta-analysis, including 330 cases of.3 patients with OSAS T2DM English of meta analysis showed that: after CPAP treatment improved the ESS, [WMD=-6.33,95%CI: (-9.01, -3.66), P0.00001], the difference was statistically significant. [WMD=-0.12,95%CI: on the level of HbA1c (-0.86,0.62), P=0.75] and BMI[WMD=-0.62,95%CI: (-2.40,1.16), P=0.49] although the visible seems to decline slightly, but the difference between before and after treatment to compare effect was not statistically significant.5 Chinese meta-analysis of studies showed that CPAP treatment group and the In the HbA1c[WMD=-0.50,95%CI: control group (-0.72, -0.28), P0.00001], FBG[WMD=-1.19,95%CI: (-1.52, -0.87), P0.00001], PBG[WMD=-1.02,95%CI: (-1.43, -0.62), there was significant difference in the P0.00001]; HOMA-IR[WMD=-1.80,95%CI: (-4.64,1.04), P =0.21], BMI[WMD=-0.69,95%CI: (-1.79,0.41), no statistically significant differences. P=0.22] CPAP can improve LSPO2[WMD=24.04,95%CI: (20.04,28.05) P0.00001], but no improvement in patients with [WMD=-23.65,95%CI: AHI (-51.24,3.93), P=0.09].
Conclusion: for patients with T2DM combined with OSAS, CPAP treatment improves LSPO2 and blood glucose control, but a large-scale study is still needed to be further confirmed.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R766;R587.1

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