Wilt Timothy J, Carlson Kathleen F, Goldish Gary D, MacDonald Roderick, Niewoehner Catherine, Rutks Indulis, Shamliyan Tatyana, Tacklind James, Taylor Brent C, Kane Robert L
Evid Rep Technol Assess (Full Rep). 2008 Jan(163):1-95.
To assess the prevalence of carbohydrate and lipid disorders in adults with chronic spinal cord injury and evaluate their risk contribution to cardiovascular diseases and the potential impact of exercise and pharmacologic and dietary therapies to alter these disorders and reduce cardiovascular disease risk.
MEDLINE (PubMed), Cochrane Database and Web sites of the American Spinal Injury Association, American Paraplegia Society, Paralyzed Veterans of America, Consortium of Spinal Cord Medicine, and WorldCat through August 2007.
English language observational studies addressing prevalence of carbohydrate and lipid disorders were included if they evaluated at least 100 adults with chronic spinal cord injury or a total of 100 subjects if using a control group. Epidemiologic investigations of more than 50 adults with spinal cord injury that were published in English after 1990 and reported cardiovascular morbidity and mortality were abstracted. Intervention studies from 1996-2007 were included regardless of design or size if they assessed exercise, diet, or pharmacologic therapies and reported carbohydrate, lipid, or cardiovascular outcomes.
The quality of evidence regarding the prevalence, impact, and outcomes of carbohydrate and lipid disorders in adults with chronic spinal cord injuries is weak. Evidence is limited by relatively few studies, small sample size, lack of appropriate control groups, failure to adjust for known confounding variables, and variation in reported outcomes. However, the existing evidence does not indicate that adults with spinal cord injuries are at markedly greater risk for carbohydrate and lipid disorders or subsequent cardiovascular morbidity and mortality than able-bodied adults. Body mass index is not reliable for assessing body composition, especially percent body fat, in adults with spinal cord injury. There are no high quality studies evaluating the impact of exercise, diet, or pharmacologic therapies on these disorders.
The available evidence does not support incorporating SCI status as an independent variable to assess risk of cardiovascular morbidity and mortality or to alter diagnostic/treatment thresholds compared to able-bodied adults. Furthermore, individuals with SCI may have unique physiologic differences compared to able-bodied individuals. As a result, it is uncertain that findings from studies conducted in able-bodied adults evaluating efficacy and harms of interventions to improve carbohydrate, lipid disorders, and subsequent CVD can be extrapolated to individuals with SCI. The role of exercise in individuals with spinal cord injuries represents a unique challenge and requires further exploration into the benefits, harms, and resource implications of broad-based spinal cord injury exercise programs.
评估慢性脊髓损伤成人中碳水化合物和脂质紊乱的患病率，评估它们对心血管疾病的风险贡献，以及运动、药物和饮食疗法对改变这些紊乱并降低心血管疾病风险的潜在影响。
截至2007年8月的MEDLINE（PubMed）、Cochrane数据库以及美国脊髓损伤协会、美国截瘫协会、美国退伍军人瘫痪者协会、脊髓医学联合会和WorldCat的网站。
纳入了关于碳水化合物和脂质紊乱患病率的英文观察性研究，如果这些研究评估了至少100名慢性脊髓损伤成人，或者在使用对照组时评估了总共100名受试者。对1990年后发表的、以英文报道且涉及50多名脊髓损伤成人的心血管发病率和死亡率的流行病学调查进行了摘要提取。纳入了1996 - 2007年的干预性研究，无论其设计或规模如何，只要它们评估了运动、饮食或药物疗法，并报告了碳水化合物、脂质或心血管方面的结果。
关于慢性脊髓损伤成人中碳水化合物和脂质紊乱的患病率、影响及结果的证据质量较弱。证据受到相对较少的研究、小样本量、缺乏合适的对照组、未对已知混杂变量进行调整以及报告结果的差异等因素的限制。然而，现有证据并未表明脊髓损伤成人患碳水化合物和脂质紊乱或随后心血管发病及死亡的风险明显高于健全成人。体重指数在评估脊髓损伤成人的身体成分，尤其是体脂百分比方面并不可靠。没有高质量的研究评估运动、饮食或药物疗法对这些紊乱的影响。
现有证据不支持将脊髓损伤状态作为一个独立变量纳入，以评估心血管发病和死亡风险或改变与健全成人相比的诊断/治疗阈值。此外，与健全个体相比，脊髓损伤个体可能存在独特的生理差异。因此，不确定在健全成人中进行的评估改善碳水化合物、脂质紊乱及后续心血管疾病的干预措施的疗效和危害的研究结果能否外推至脊髓损伤个体。运动在脊髓损伤个体中的作用是一个独特的挑战，需要进一步探索广泛的脊髓损伤运动项目的益处、危害及资源影响。
