PLOS ONE：合并抑郁增加糖尿病患者死亡风险

　　一项新的研究表明，合并抑郁可使糖尿病患者死亡风险增高1.5倍。研究由荷兰马斯特里赫特大学医学中心van Dooren等人进行，于2013年3月5日在线发表于《PLoS One》杂志[PLoS One. 2013;8(3):e57058]。

　　研究者在PUBMED和PSYCINFO数据库中检索截至2012年8月16日的主题为糖尿病患者抑郁相关死亡风险的文章，通过系统性回顾文献和对纵向研究的荟萃分析探讨糖尿病患者心血管死亡率与抑郁及全因死亡之间的相关性，应用随机效应模型计算危险比。

　　最终16项评估了全因死亡率的研究符合纳入标准，其中5项研究评估了心血管死亡率。研究者在校正人口、微血管及大血管并发症等因素后发现，抑郁与糖尿病患者全因死亡风险增加相关（HR=1.46，95%可信区间1.29-1.66），与心血管死亡率相关（HR=1.39，95%可信区间1.11-1.73）。

　　全因死亡在不同研究之间的异质性较高，而心血管死亡的异质性相对较低，I平方分别为78.6%和39.6%。亚组分析显示，抑郁和死亡率的相关性在排除三篇统计比值比的文章后无明显变化，而异质性明显降低（HR=1.49，95%可信区间=1.39-1.61，I平方=15.1%）。

　　研究者指出，在进一步的研究中应关注抑郁相关的心血管与非心血管原因所致死亡，及其潜在的行为学与生理学机制。

Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis

OBJECTIVE:

To examine the association between depression and all-cause and cardiovascular mortality in people with diabetes by systematically reviewing the literature and carrying out a meta-analysis of relevant longitudinal studies.

RESEARCH DESIGN AND METHODS:

PUBMED and PSYCINFO were searched for articles assessing mortality risk associated with depression in diabetes up until August 16, 2012. The pooled hazard ratios were calculated using random-effects models.

RESULTS:

Sixteen studies met the inclusion criteria, which were pooled in an overall all-cause mortality estimate, and five in a cardiovascular mortality estimate. After adjustment for demographic variables and micro- and macrovascular complications, depression was associated with an increased risk of all-cause mortality (HR = 1.46, 95% CI = 1.29-1.66), and cardiovascular mortality (HR = 1.39, 95% CI = 1.11-1.73). Heterogeneity across studies was high for all-cause mortality and relatively low for cardiovascular mortality, with an I-squared of respectively 78.6% and 39.6%. Subgroup analyses showed that the association between depression and mortality not significantly change when excluding three articles presenting odds ratios, yet this decreased heterogeneity substantially (HR = 1.49, 95% CI = 1.39-1.61, I-squared = 15.1%). A comparison between type 1 and type 2 diabetes could not be undertaken, as only one study reported on type 1 diabetes specifically.

CONCLUSIONS:

Depression is associated with an almost 1.5-fold increased risk of mortality in people with diabetes. Research should focus on both cardiovascular and non-cardiovascular causes of death associated with depression, and determine the underlying behavioral and physiological mechanisms that may explain this association.