OSAHS与高血压相关性的系统评价

发布时间：2018-12-28 21:24

【摘要】：目的：运用循证医学系统评价的方法评估阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与高血压之间的相关性。方法：采用Cochrane系统评价的研究方法，确定研究课题，制定合适的纳入标准及排除标准。按照纳入及排除标准制定合理的检索策略检索相关文献。计算机检索COCHRANE图书馆、MEDLINE（1950~2011.4）EMBASE(1989~2011.4)、维普VIP(1989~2011.4)、万方（1977~2011.4）、中国生物医学文献数据库CBM（1978~2011.4）、相关期刊论文CNKI（1979~2011.4），查找公开发表的OSAHS与高血压相关性的文献。查找相关会议文献及未公开发表的相关文章，咨询本领域专家以获得相关资料。根据纳入排除标准对检出文献进行筛选，纳入OSAHS与高血压相关性的队列研究和病例对照研究。整理纳入文献，对纳入文献质量进行评估，提取相关数据。收集资料、评估纳入研究质量工作由两名研究员独立完成。运用RevMan5.1.2软件分析纳入文献，评估文献的异质性，按照研究类型及OSAHS病情分级分别进行META分析，评估OSAHS与高血压直接的相关性及相关性是否与OSAHS病情分级有关。评估纳入文献的发表偏移。运用GRADE3.6软件评估证据质量。结果：共检出相关文献2224篇，初筛选出89篇，复筛排除79篇，最终共纳入文献11篇，观察对象总计4019名。其中，前瞻性队列研究1篇，观察病例346人；病例对照研究10篇，观察病例3673人。按照异质性分析结果，将纳入文献分成不同的亚组进行分析并绘制森林图。Meta分析结果显示：①按照研究类型将纳入文献分为病例对照组及队列研究组。META分析结果显示P=0.16，，RR=2.52，95%CI（2.21,2.87），说明病例组与对照组之间的差异有统计学意义，提示OSAHS与高血压之间存在相关性;②按照OSAHS病情分级，将纳入文献分为轻度、中度及重度3个亚组。META分析结果显示P=0. 83，RR=1.84，95%CI（1.53,2.22），说明病例组与对照组之间的差异有统计学意义，提示OSAHS与高血压的相关性与OSAHS病情分级有关。且OSAHS分级越重，患者患高血压可能性越大。发表偏倚分析结果显示“漏斗图”图形不对称，提示可能存在发表偏倚。运用GRADE软件分析纳入文献质量等级，结果为“very low”。结论：现有证据表明，OSAHS与高血压呈显著相关，可能互为危险因素。且OSAHS与高血压相关性可能与OSAHS病情分级有关，OSAHS病情越重，并发高血压的可能性就越大。本研究纳入文献质量等级较低，目前缺乏大量的、高质量的针对OSAHS与高血压相关性的研究，特别是前瞻性队列研究。
[Abstract]:Objective: to evaluate the correlation between obstructive sleep apnea hypopnea syndrome (OSAHS) and hypertension by the method of evidence-based medicine system evaluation. Methods: Cochrane system evaluation method was used to determine the research topics and to formulate appropriate inclusion criteria and exclusion criteria. According to the inclusion and exclusion criteria to formulate a reasonable retrieval strategy to retrieve relevant literature. Computer search for COCHRANE Library (, MEDLINE (1950 / 2011.4) EMBASE (1989 / 2011.4), Weip VIP (1989 / 2011.4), Wanfang (1977 / 2011.4), Chinese Biomedical Literature Database CBM (1978 / 2011.4), China Journal Full-text Database (CNKI (1979 / 2011.4), Chinese Journal Database (1979 / 2011.4), China Biomedical Literature Database CBM (1978 / 2011.4) Find published literature on the association of OSAHS with hypertension. Find relevant conference documents and unpublished articles, consult experts in this field to obtain relevant information. The literature was screened according to the inclusion exclusion criteria, and the cohort study and case-control study on the correlation between OSAHS and hypertension were carried out. Collate the literature, evaluate the quality of the literature, and extract the relevant data. Collecting data and evaluating the quality of the research were done independently by two researchers. The RevMan5.1.2 software was used to analyze the literature to evaluate the heterogeneity of the literature. According to the type of study and the grade of OSAHS, the META analysis was carried out to assess the direct correlation between OSAHS and hypertension and whether the correlation was related to the grade of OSAHS. The evaluation includes publication offsets of the literature. Use GRADE3.6 software to evaluate the quality of evidence. Results: a total of 2224 articles were identified, 89 articles were screened out, 79 articles were excluded, and 11 papers were included. A total of 4019 subjects were observed. There were 1 prospective cohort study with 346 cases observed and 10 case-control studies with 3673 cases observed. According to the results of heterogeneity analysis, The results of Meta analysis showed that: (1) according to the type of study, the included literature was divided into case control group and cohort study group. RR=2.52,95%CI (2.21 卤2.87), indicating that the difference between the case group and the control group is statistically significant, suggesting that there is a correlation between OSAHS and hypertension. 2 according to the grade of OSAHS, the included literature was divided into three subgroups: mild, moderate and severe. META analysis showed that P0. The CI (1.83 卤2.22) indicated that the difference between the case group and the control group was statistically significant, suggesting that the correlation between OSAHS and hypertension was related to the grade of OSAHS. And the more severe the OSAHS grade, the more likely patients are to develop hypertension. The results of publication bias analysis showed that the funnel graph was asymmetrical, suggesting that there might be publication bias. GRADE software was used to analyze the literature quality and the result was "very low". Conclusion: available evidence suggests that OSAHS is significantly associated with hypertension and may be a risk factor. The correlation between OSAHS and hypertension may be related to the grade of OSAHS. The more serious the OSAHS, the more likely it is to develop hypertension. This study included a low quality literature, and a large number of high-quality studies on the association between OSAHS and hypertension, especially prospective cohort studies, were lacking.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R766;R544.1

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