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Clin Appl Thromb Hemost:一项Meta分析:他汀类药物治疗对2型糖尿病患者糖尿病视网膜病变的影响

2021-10-18 “心关注”公众号 “心关注”公众号

近年来,糖尿病(DM)在世界范围内发病率较高。最常见的是2型糖尿病(T2DM),好发于成人。T2DM患者发生微血管和大血管并发症的风险较高。T2DM的血管并发症一直广受关注。大血管并发症主要包括脑血管

近年来,糖尿病(DM)在世界范围内发病率较高。最常见的是2型糖尿病(T2DM),好发于成人。T2DM患者发生微血管和大血管并发症的风险较高。T2DM的血管并发症一直广受关注。大血管并发症主要包括脑血管疾病、心血管疾病和外周动脉疾病,发病率和死亡率均较高。DR(糖尿病视网膜病变)是T2DM严重的微血管并发症之一,可导致糖尿病患者视力下降。控制胆固醇有利于预防大血管事件,控制血糖有利于预防微血管事件。然而,DR与血脂异常之间的关系并不一致。

他汀类药物可有效降低血清胆固醇水平。他汀类药物治疗对糖尿病患者血管事件的一级预防是有效的。一项研究表明,他汀类药物治疗可降低未诊断为闭塞性动脉疾病的糖尿病患者的主要血管事件发生率。目前,他汀类药物已被广泛应用于动脉粥样硬化性心血管疾病的一级和二级预防。然而,一些研究表明他汀类药物可能增加新发DMs的患病率。此外,他汀类药物的使用可能会增加糖尿病患者的血糖水平,从而增加糖尿病患者发生DR的风险。强化治疗可以减缓胰岛素依赖型糖尿病患者的DR进展。Adhyaru等人已经证实了他汀类药物治疗的益处和不利影响。

他汀类药物使用与糖尿病患者微血管疾病之间的关系目前尚不清楚。此外,他汀类药物对DR的作用目前仍存在争议,已成为人们关注的焦点。他汀类药物的使用可以降低DR的风险并延缓视网膜病变的发展。目前尚不清楚他汀类药物的使用是否与DR的高发病率有关。因此,研究人员进行了这项meta分析,研究他汀类药物的使用与T2DM患者DR发生率的关系。

方法

分别在PubMed,EMBASE和Cochrane图书馆的数据库中搜索了从开始到2020年9月25日报告他汀类药物使用与DR之间关系的合格研究。搜索关键词包括糖尿病,2型,羟甲基戊二酰辅酶A还原酶抑制剂和糖尿病性视网膜病变。结果显示为使用随机效应模型计算的具有95%置信区间(CI)的优势比(OR)。

结果

共有6项符合条件的研究,包含43,826名患者纳入荟萃分析。荟萃分析显示他汀类药物与DR风险升高无关(OR=0.96;95%CI 0.80-1.16;P =0.68)。同样,在≥500 (OR=0.98;95%CI 0.80-1.21)或<500 (OR=0.90;95%CI 0.49-1.66)的参与者中,他汀类药物和安慰剂之间没有差异。(图1)

图1.他汀类药物治疗对DR的影响

此外,研究人员进行了一项荟萃分析,根据年龄研究他汀类药物治疗对2型糖尿病患者DR的影响,发现他汀类药物使用与40岁以上2型糖尿病患者DR风险降低相关(OR=0.87 ;95%CI 0.82-0.92)。(图2)

图2. 他汀类药物治疗对40岁及以上2型糖尿病患者DR的影响

结论

荟萃分析显示,他汀类药物与T2DM患者DR风险升高无关。此外,他汀类药物的使用与40岁以上2型糖尿病患者DR发生率较低有关。

原始出处:

Liu J et al. Effect of Statin Therapy on Diabetes Retinopathy in People With Type 2 Diabetes Mellitus: A Meta-Analysis. Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211040109. doi: 10.1177/10760296211040109. PMID: 34617462.

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    2022-02-14 guojianrong
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    2022-06-06 一闲
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    2021-10-20 zutt
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