Lu Lin, Fu Deng-Lei, Li Hui-Qin, Liu Ai-Ju, Li Ji-Huang, Zheng Guo-Qing
Department of Neurology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
PLoS One. 2014 Jan 21;9(1):e85781. doi: 10.1371/journal.pone.0085781. eCollection 2014.
Whether diabetes increases the risk of Parkinson's disease (PD) is still inconclusive. The objective of this updated meta-analysis is to synthesize evidence from case-control studies that evaluated the association between diabetes and the risk of PD.
Seven databases were searched to identify case-control studies that evaluated the association between diabetes and PD. The methodological quality of included studies was assessed using Newcastle-Ottawa scale. All data were analyzed using Review Manager 5.1 software. Subgroup analyses were also adopted, according to stratification on gender, geographic location, source of the control group, smoking, anti-diabetes drug prescription and duration of DM.
Fourteen studies fulfilled inclusion criteria for meta-analysis, yielding a total of 21395 PD patients and 84579 control subjects. Individuals with diabetes were found to have a negative association with future PD (OR 0.75; 95% CI 0.58-0.98) in spite of significant heterogeneity. In subgroup analyses, the negative correlation was still found in studies from North America, non-PD control groups from general population, never smoking individuals, and DM ascertainment based on questionnaire or self-report. Stratification of gender and DM duration showed no significant association. No association was also found in European and Asian individuals, hospital-based controls, ever smoking subjects, DM assessment by medical record or physician diagnosis, and insulin prescription for DM.
Evidence from case-control studies suggested that diabetic individuals may have a decreased incidence of PD despite significant heterogeneity. More researches are warranted to clarify an understanding of the association between diabetes and risk of PD.
糖尿病是否会增加帕金森病（PD）的风险尚无定论。这项更新的荟萃分析的目的是综合病例对照研究的证据，以评估糖尿病与PD风险之间的关联。
检索七个数据库，以确定评估糖尿病与PD之间关联的病例对照研究。使用纽卡斯尔-渥太华量表评估纳入研究的方法学质量。所有数据均使用Review Manager 5.1软件进行分析。还根据性别、地理位置、对照组来源、吸烟情况、抗糖尿病药物处方和糖尿病病程进行分层，采用亚组分析。
十四项研究符合荟萃分析的纳入标准，共纳入21395例PD患者和84579例对照受试者。尽管存在显著异质性，但发现糖尿病患者与未来发生PD呈负相关（比值比0.75；95%置信区间0.58-0.98）。在亚组分析中，北美地区的研究、来自普通人群的非PD对照组、从不吸烟的个体以及基于问卷或自我报告确定的糖尿病患者中仍发现负相关。按性别和糖尿病病程分层未显示出显著关联。在欧洲和亚洲个体、基于医院的对照组、曾经吸烟的受试者、通过病历或医生诊断评估的糖尿病患者以及糖尿病患者的胰岛素处方中也未发现关联。
病例对照研究的证据表明，尽管存在显著异质性，但糖尿病个体患PD的发生率可能会降低。需要更多研究来阐明对糖尿病与PD风险之间关联的理解。
