摘要
目的荟萃分析方法评价持续气道正压通气（CPAP）对中国阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者胰岛素抵抗的影响。方法计算机检索PubMed、中国学术期刊全文数据库、中国生物医学文献数据库、万方资源数据库、重庆维普网和中国重要会议论文全文数据库并手工检索相关期刊，全面收集持续气道正压通气对我国阻塞性睡眠呼吸暂停低通气综合征胰岛素抵抗的临床研究，按照纳入、排除标准选择试验并评价质量，采用Stata11．0软件进行荟萃分析。结果最终纳入13篇文献。荟萃分析结果显示：CPAP治疗后单纯OSAHS患者及OSAHS合并糖尿病患者空腹血糖（FBG）明显降低，差异有统计学意义[WMD：0．473，95％CI（0．157，0．790），P=0．003；WMD=1．358，95％CI（0．921，1．794），P=0]。CPAP对两组患者空腹胰岛素（FINS）未见明显影响[WMD=0．624，95％CI（-0．512，1．759），P=0．282；WMD=0．275，95％CI（-0．416，0．965），P=0．435]。CPAP能降低两组患者胰岛素抵抗指数（HOMA-IR），差异有统计学意义[WMD=0．483，95％CI（0．119，0．846），P=0．009；WMD=0．726，95％CI（0．023，1．430），P〈0．05]。CPAP对OSAHS合并糖尿病患者糖化血红蛋白（HbAlc）有影响，差异有统计学意义[WMD=1．03，95％CI（0．71，1．34），P〈0．05]。CPAP治疗前后FBG、FINS、HOMA-IR、HbAlc漏斗图均基本呈现下宽上窄左右对称的图形，经Egger检验后，提示单纯OSAHS组HOMA—IR存在明显发表偏倚，其余指标均不存在明显发表偏倚。结论无论是否合并糖尿病，CPAP均改善我国OSAHS患者胰岛素抵抗。
Objective To evaluate the impact of continuous positive airway pressure on insulin resistance in obstructive sleep apnea hypopnea syndrome （OSAHS） in Chinese by meta-analysis. Methods The clinical trials involving continuous positive airway pressure on glueose metabolism in OSAHS in Chinese were searched and identified from PubMed, China Academic Journals full-text database, Chinese Biomedical Literature Database, Wanfang Resource Database, Chongqing VIP and Chinese Journal full-text database. According to inclusion and exclusion criteria and to evaluate the quality of choice experiment, and then extract the valid data. The Stata 11.0 software was used to carry out meta-analysis. Results The data part of the results should be added to the 95% confidence interval and 13 articles were ultimately included. Meta analysis showed fasting blood glucose （FBG） was significantly decreased in patients with OSAHS and OSAHS patients with diabetes mellitus after CPAP therapy （WMD = 0. 473, 95% CI（0. 157,0. 790）, P = 0. 003 ;WMD = 1. 358,95% CI （0. 921,1. 794） , P = 0 ）. CPAP had no obvious effect on fasting insulin （FINS） （WMD =0.624, 95%CI（ -0.512,1.759）,P =0.282;WMD =0.275, 95% CI（ -0.416, 0. 965）,P=0. 435）. Whereas it eould significantly reduce insulin resistance index （HOMA-IR） in two groups （WMD =0.483, 95% CI（0. 119,0. 846） ,P = 0. 009;WMD =0. 726, 95% CI（0. 023,1. 430） ,P 〈 0. 05 ）. In addition, CPAP affected HbAlc in diabetic patients with OSAHS, the difference was statisticallysignificant （WMD = 1.03, 95% CI（0. 71,1.34） ,P 〈 0. 05）. The funnel plots of FBG, FINS, HOMA-IR, and HbAlc were basically rendered under the wide and narrow symmetrical graphics before and after CPAP treatment, according to Egger＇ s examination, there had obvious publication bias in HOMA-IR in OSAHS group, the other indexes did not exist significant publication bias. Conclusion CPAP can improve insulin resistance in patients with OSAHS whether or not with diabetes. However, due to the quality and the limitations of the studies, more high-quality, large-scale randomized controlled clinical trials are required to be verified.
出处
《中华糖尿病杂志》
CAS
2012年第12期718-722,共5页
CHINESE JOURNAL OF DIABETES MELLITUS
