Vascular and Endovascular Surgery Unit, Hospital S. Maria Misericordia, University of Perugia, Perugia, Italy.
Vascular and Endovascular Surgery Unit, Hospital S. Maria Misericordia, University of Perugia, Perugia, Italy.
Eur J Vasc Endovasc Surg. 2014 Mar;47(3):243-61. doi: 10.1016/j.ejvs.2013.12.007. Epub 2014 Jan 18.
Epidemiologic evidence suggests that patients with diabetes may have a lower incidence of abdominal aortic aneurysm (AAA); however, the link between diabetes and AAA development and expansion is unclear. The aim of this review is to analyze updated evidence to better understand the impact of diabetes on prevalence, incidence, clinical outcome, and expansion rate of AAA. A systematic review of literature published in the last 20 years using the PubMed and Cochrane databases was undertaken. Studies reporting appropriate data were identified and a meta-analysis performed using the generic inverse variance method. Sixty-four studies were identified. Methodological quality was "fair" in 16 and "good" in 44 studies according to a formal assessment checklist (Newcastle-Ottawa). In 17 large population prevalence studies there was a significant inverse association between diabetes and AAA: pooled odds ratio (OR) 0.80; 95% confidence intervals (CI) 0.70-0.90 (p = .0009). An inverse association was also confirmed by pooled analysis of data from smaller prevalence studies on selected populations (OR 0.59; 95% CI 0.35-0.99; p = .05), while no significant results were provided by case-control studies. A significant lower pooled incidence of new AAA in diabetics was found over six prospective studies: OR 0.54; 95% CI 0.31-0.91; p = .03. Diabetic patients showed increased operative (30-day/in-hospital) mortality after AAA repair: pooled OR 1.26; 95% CI 1.10-1.44; p = .0008. The increased operative risk was more evident in studies with 30-day assessment. In the long-term, diabetics showed lower survival rates at 2-5 years, while there was general evidence of lower growth rates of small AAA in patients with diabetes compared to non-diabetics. There is currently evidence to support an inverse relationship between diabetes and AAA development and enlargement, even though fair methodological quality or unclear risk of bias in many available studies decreases the strength of the finding. At the same time, operative and long-term survival is lower in diabetic patients, suggesting increased cardiovascular burden. The higher mortality in diabetics raises the question as to whether AAA repair should be individualized in selected diabetic populations at higher AAA rupture risk.
流行病学证据表明，糖尿病患者患腹主动脉瘤 (AAA) 的发病率可能较低；然而，糖尿病与 AAA 发展和扩张之间的联系尚不清楚。本综述的目的是分析最新的证据，以更好地了解糖尿病对 AAA 的患病率、发病率、临床结局和扩张率的影响。使用 PubMed 和 Cochrane 数据库对过去 20 年发表的文献进行了系统的综述。确定了报告适当数据的研究，并使用通用逆方差法进行了荟萃分析。共确定了 64 项研究。根据正式评估检查表 (纽卡斯尔-渥太华)，16 项研究的方法学质量为“中等”，44 项研究的方法学质量为“良好”。在 17 项大型人群患病率研究中，糖尿病与 AAA 之间存在显著的负相关：汇总优势比 (OR) 0.80；95%置信区间 (CI) 0.70-0.90(p =.0009)。对来自选定人群的较小患病率研究数据的汇总分析也证实了这种负相关关系 (OR 0.59；95%CI 0.35-0.99；p =.05)，而病例对照研究则没有提供显著结果。六项前瞻性研究发现，糖尿病患者新发 AAA 的发病率显著降低：OR 0.54；95%CI 0.31-0.91；p =.03。糖尿病患者在接受 AAA 修复后，手术 (30 天/住院) 死亡率增加：汇总 OR 1.26；95%CI 1.10-1.44；p =.0008。在具有 30 天评估的研究中，手术风险增加更为明显。在长期随访中，糖尿病患者在 2-5 年内的生存率较低，而与非糖尿病患者相比，糖尿病患者的小 AAA 生长速度普遍较低。目前有证据支持糖尿病与 AAA 的发展和扩大之间存在负相关关系，尽管许多现有研究的方法学质量中等或存在偏倚风险，降低了这一发现的强度。与此同时，糖尿病患者的手术和长期生存率较低，表明心血管负担增加。糖尿病患者的死亡率较高，引发了 AAA 修复是否应在 AAA 破裂风险较高的特定糖尿病人群中个体化的问题。
