Wang Peng, Xu Yuan-Yuan, Lv Tian-Tian, Guan Shi-Yang, Li Xiao-Mei, Li Xiang-Pei, Pan Hai-Feng
1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
2 Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China.
Angiology. 2019 Feb;70(2):141-159. doi: 10.1177/0003319718787366. Epub 2018 Jul 15.
Cardiovascular (CV) risk in type 1 diabetes mellitus (T1DM) is increased. In this study, we evaluated the differences in major markers of CV risk between patients with T1DM and healthy controls by a systematic review and meta-analysis. Literature from PubMed, EMBASE, and The Cochrane Library comparing CV risk markers between patients with T1DM and controls was obtained. The overall standard mean differences (SMDs) of carotid intima-media thickness (cIMT), endothelium-dependent flow-mediated dilation (FMD%), carotid-femoral pulse wave velocity (cf-PWV), and glyceryl trinitrate-mediated dilatation (GTN%) with its 95% confidence interval (CI) between patients with T1DM and control groups were calculated using fixed-effect or random-effect model. Heterogeneity was evaluated using the Cochran Q and I statistics. The results showed that patients with T1DM had a significantly greater cIMT (SMD: 0.89; 95% CI, 0.69-1.09; P < .001), significantly lower FMD% (SMD: -1.45%; 95% CI, -1.74 to -1.17; P < .001), significantly increased cf-PWV (SMD: 0.57; 95% CI, 0.03-1.11; P < .001), and significantly decreased GTN% (SMD: -1.11; 95% CI, -1.55 to -0.66; P < .001) than controls. Our results support the current evidence for an elevated CV burden in patients with T1DM and affirm the clinical utility of markers of subclinical atherosclerosis in the management of these patients.
1型糖尿病（T1DM）患者的心血管（CV）风险会增加。在本研究中，我们通过系统评价和荟萃分析评估了T1DM患者与健康对照者之间CV风险主要标志物的差异。获取了来自PubMed、EMBASE和Cochrane图书馆中比较T1DM患者与对照者CV风险标志物的文献。使用固定效应或随机效应模型计算了T1DM患者与对照组之间颈动脉内膜中层厚度（cIMT）、内皮依赖性血流介导的血管舒张（FMD%）、颈股脉搏波速度（cf-PWV）和硝酸甘油介导的血管舒张（GTN%）的总体标准平均差异（SMD）及其95%置信区间（CI）。使用Cochran Q和I统计量评估异质性。结果显示，与对照组相比T1DM患者的cIMT显著更大（SMD：0.89；95%CI，0.69 - 1.09；P <.001），FMD%显著更低（SMD：-1.45%；95%CI，-1.74至-1.17；P <.001），cf-PWV显著增加（SMD：0.57；95%CI，0.03 - 1.11；P <.001），GTN%显著降低（SMD：-1.11；95%CI，-1.55至-0.66；P <.001）。我们的结果支持了目前关于T1DM患者CV负担增加的证据，并肯定了亚临床动脉粥样硬化标志物在这些患者管理中的临床实用性。
