茶及其提取物改善代谢综合征各组分的有效性与安全性的Meta分析

发布时间：2018-08-11 14:44

【摘要】：【背景】代谢综合征(metabolic syndrome,MS)是一系列相互关联的代谢异常的危险因素的组合,包括中心性肥胖、高血糖(糖调节受损或2型糖尿病)、血脂代谢异常及高血压病等,是一组严重威胁机体健康的症候群。这一系列代谢紊乱对人类健康造成了严重的危害。近20年来,随着我国人民生活水平的不断提高,饮食结构与方式的不断转变及人口老龄化的加速,使得MS的发病率急剧升高。据统计,1992年,我国18岁以上人群中,MS发病率为13.3%,至2000年初,35岁以上人群MS发病率已然上升至16.5%,而在2013年的最新统计中,MS在我国成年人中发病率更是高达24%。MS已成为一种新兴的慢性代谢性疾病,更是一项亟待广泛关注与严格防控的社会公共卫生问题。目前,对于改善MS患者代谢状态的措施主要包括改善生活方式、减少及优化能量摄入、增加体育锻炼、服用药物及手术治疗。其中,改变膳食结构是最基础、最经济的调整生活方式的方法。饮茶文化源于中国,并在世界各地广为传播,历史悠久。茶叶作为一种天然的绿色植物饮品,其有效活性提取物对多种疾病的保健与治疗功效,在国内外许多相关研究中被报道。然而,茶对于MS患者的食疗作用及对患高血压、糖尿病、肥胖等疾病组分的具体影响尚不清楚。因此,本课题拟采用Meta分析的方法,以国内外研究报道为数据资料,旨在系统评价茶及其提取物(TE)改善MS患者各组分指标的有效性与安全性,为TE对MS的饮食营养诊疗作用提供客观而又强有力的循证医学证据。【目的】通过Meta分析的方法,系统评价绿茶、红茶和乌龙茶三类品种的茶叶及其提取物对MS患者代谢异常的生理测量指标、脂质代谢生化指标、糖代谢生化指标及血压等15项指标的影响,评估TE对MS患者治疗的有效性及安全性。【方法】严格试验设计,制定合理的纳入及排除标准,2位研究者分别独立使用检索策略:(tea(extract)OR green tea(extract)OR black tea(extract)OR oolong tea(extract))AND(obesity OR metabolic syndrome),计算机检索Pub Med(1980~2014)、Psyc INFO(1980~2014)、Scopus(1980~2014)、EMBase(1980~2014)、The Cochrane Library 5大国际权威数据库,全面收集国际上所有关于TE与对照组相比,改善MS患者任一组分指标的随机对照试验(RCTs)。统计学分析及结论展示采用Review manager 5.2.2软件进行。合并计算优势比(OR)和95%可信区间(CI)作为荟萃变量。【结果】1.本研究通过制定合理的标准,对检索到的所有相关文献进行严格的筛选,并运用Meta分析的统计学方法,最终共计纳入合格的RCT文献16篇,其中,绿茶(或提取物)作为干预的RCT研究12篇,红茶(或提取物)作为干预的RCT研究4篇,乌龙茶(或提取物)作为干预的RCT研究0篇。16项研究囊括的受试者共1090名,至治疗终点时,共计138名受试者每日饮用或服用红茶(或提取物)饮料或胶囊,451名受试者每日饮用或服用绿茶(或提取物)饮料或胶囊,446名受试者每日饮用或服用同等剂量的安慰剂饮料或胶囊。2.生理测量指标:在治疗终点,干预组与对照组对比显示,TE可以有效的降低MS患者的体重水平[SMD=-0.21,95%CI(-0.33,-0.09),P=0.0007],腰围水平[SMD=-0.24,95%CI(-0.38,-0.09),P=0.001]及身体质量指数(BMI)值[SMD=-0.27,95%CI(-0.40,-0.15),P0.0001],差异具有统计学意义,对于MS患者的腰围-臀围比和臀围两项指标,结果显示两组差异无统计学意义。3.脂质代谢生化指标:在治疗终点,干预组与对照组对比显示,TE可以有效的降低MS患者低密度脂蛋白胆固醇(LDL-C)水平[SMD=-0.31,95%CI(-0.55,-0.06),P=0.01],升高高密度脂蛋白胆固醇(HDL-C)水平[SMD=0.18,95%CI(0.01,0.35),P=0.03],差异具有统计学意义,对于MS患者的胆固醇(TC)水平与甘油三酯(TG)水平两项指标,结果显示两组差异无统计学意义。4.糖代谢生化测量指标:在治疗终点,干预组与对照组对比显示,TE可以有效的降低MS患者空腹血糖水平[SMD=-0.22,95%CI(-0.34,-0.10),P=0.0003],差异有统计学意义,对于胰岛素抵抗指数、胰岛素水平和糖化血红蛋白水平,结果显示两组差异无统计学意义。5.血压:在治疗终点,干预组与对照组对比显示,平均坐位收缩压(ms SBP)与平均坐位舒张压(ms DBP)两项指标组间差异无统计学意义。6.安全性指标:在治疗终点,TE组与对照组总体不良事件发生率组间差异无统计学意义[OR=0.99,95%CI(0.55,1.77),P=0.97]。【结论】1.TE能有效改善MS患者的体重、腰围与BMI值。2.TE能有效降低MS患者血LDL-C水平并提升HDL-C水平。3.TE能有效降低MS患者空腹血糖水平,但对胰岛素水平、Hb A1c及HOME-IR的无明显改善作用。4.TE对血压无明显的改善作用。5.TE具有良好的安全性,未发现严重的不良反应事件。
[Abstract]:[Background] Metabolic syndrome (MS) is a combination of a series of risk factors associated with metabolic abnormalities, including central obesity, hyperglycemia (impaired glucose regulation or type 2 diabetes mellitus), dyslipidemia and hypertension, which are a serious threat to human health. Recent 20 years, with the continuous improvement of people's living standards, the constant change of dietary structure and pattern, and the acceleration of population aging, the incidence of MS has risen sharply. According to statistics, in 1992, the incidence of MS was 13.3% in the population over 18 years old. By the beginning of 2000, the incidence of MS in the population over 35 years old had already risen. In the latest statistics in 2013, the incidence of MS in Chinese adults is as high as 24%. MS has become a new chronic metabolic disease, but also a social and public health problem that needs extensive attention and strict prevention and control. Among them, changing the dietary structure is the most basic and economical way to adjust life style. Tea drinking culture originated in China and has been widely spread all over the world for a long time. However, the specific effects of tea on the diet of MS patients and on the components of hypertension, diabetes, obesity and other diseases are still unclear. Therefore, this topic intends to adopt the method of Meta-analysis, taking the domestic and foreign research reports as data, aiming to systematically evaluate tea and obesity. Its extracts (TE) can improve the efficacy and safety of components in MS patients, and provide objective and strong evidence-based medical evidence for dietary nutrition of MS patients. To evaluate the efficacy and safety of TE in the treatment of MS patients by measuring indexes, biochemical indexes of lipid metabolism, biochemical indexes of glucose metabolism and blood pressure. A (extract) OR oolong tea (extract) AND (obesity or metabolic syndrome), a computer search Pub Med (1980-2014), Psyc INFO (1980-2014), Scopus (1980-2014), EMBase (1980-2014), The Cochrane Library 5 major international authoritative databases, comprehensively collect international information on TE as compared with the control group to improve any component of the indicators of MS patients with Computer-controlled trials (RCTs). Statistical analysis and conclusion display were performed using Review Manager 5.2.2 software. The combined odds ratio (OR) and 95% confidence interval (CI) were used as meta-variables. [Results] 1. This study strictly screened all relevant literature retrieved by setting reasonable criteria, and used the statistical side of Meta-analysis. Methods A total of 16 eligible RCT literatures were included, including 12 RCT studies using green tea (or extract) as intervention, 4 RCT studies using black tea (or extract) as intervention, and 0 RCT studies using oolong tea (or extract) as intervention. A total of 1 090 subjects were included in the 16 RCT studies. By the end of treatment, 138 subjects drank or drank it daily. Taking black tea (or extract) drinks or capsules, 451 subjects drank or took green tea (or extract) drinks or capsules daily, 446 subjects drank or took the same dose of placebo drinks or capsules daily. 2. Physiological measurements: At the end of treatment, TE significantly reduced the body size of MS patients compared with control groups. Weight level [SMD = - 0.21, 95% CI (- 0.33, - 0.09), P = 0.0007], waist circumference level [SMD = - 0.24, 95% CI (- 0.38, - 0.09), P = 0.001] and body mass index (BMI) value [SMD = - 0.27, 95% CI (- 0.40, - 0.15), P 0.0001], the difference was statistically significant. For the waist-hip circumference ratio and hip circumference of MS patients, the results showed that there was no significant difference between the two groups. Biochemical indicators of quality metabolism: At the end of treatment, TE can effectively reduce the level of low-density lipoprotein cholesterol (LDL-C) in MS patients compared with the control group [SMD = - 0.31, 95% CI (- 0.55, - 0.06), P = 0.01], increase the level of high-density lipoprotein cholesterol (HDL-C) [SMD = 0.18, 95% CI (0.01, 0.35), P = 0.03], the difference is statistically significant, for MS. There was no significant difference between the two groups in the levels of cholesterol (TC) and triglyceride (TG). 4. Biochemical measurements of glucose metabolism: At the end of treatment, TE significantly decreased fasting blood glucose levels in MS patients [SMD = - 0.22, 95% CI (- 0.34, - 0.10), P = 0.0003]. Blood pressure: At the end of treatment, the mean sitting systolic blood pressure (ms SBP) and mean sitting diastolic blood pressure (ms DBP) were not significantly different between the intervention group and the control group. At the end of treatment, there was no significant difference in overall adverse event incidence between TE group and control group [OR = 0.99, 95% CI (0.55, 1.77), P = 0.97]. However, Hb A1c and HOME-IR did not significantly improve insulin levels. 4. TE did not significantly improve blood pressure. 5. TE had good safety and no serious adverse events were found.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R589

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