撒哈拉以南非洲地区 HIV 阳性和 HIV 阴性人群中代谢综合征的流行情况：系统评价和荟萃分析。
Prevalence of metabolic syndrome among HIV-positive and HIV-negative populations in sub-Saharan Africa-a systematic review and meta-analysis.
机构信息
Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA.
出版信息
Syst Rev. 2019 Jan 3;8(1):4. doi: 10.1186/s13643-018-0927-y.
BACKGROUND
Metabolic syndrome (MetS) is a constellation of conditions that increase the risk of cardiovascular diseases. It is an emerging concern in sub-Saharan African (SSA) countries, particularly because of an increasingly aging population and lifestyle changes. There is an increased risk of MetS and its components among people living with Human immune deficiency syndrome (HIV) individuals; however, the prevalence of metabolic syndrome in the SSA population and its differential contribution by HIV status is not yet established. This systematic review and meta-analysis were conducted to estimate the pooled prevalence of metabolic syndrome in people living with HIV and uninfected populations, its variation by sub-components.
METHODS
We performed a comprehensive search on major databases-MEDLINE (PubMed), EBSCOhost, and Cochrane Database of Systematic Reviews and Web of sciences for original epidemiological research articles that compared proportions of the MetS and its subcomponents between people living with HIV and uninfected patients and published between January 1990-December 2017. The inclusion criteria were adults aged ≥ 18 years, with confirmed HIV status. We assessed the risk of bias using a prevalence studies tool, and random effect meta-analyses were used to compute the pooled overall prevalence.
RESULTS
A total of four cross-sectional studies comprising 496 HIV uninfected and 731 infected participants were included in the meta-analysis. The overall prevalence of MetS among people living with HIV was 21.5% (95% CI 15.09-26.86) versus uninfected 12.0% (95% CI 5.00-21.00%), with substantial heterogeneity. The reported relative risk estimate for MetS among the two groups was twofold (RR 1.83, 95% CI 0.98-3.41), with an estimated predictive interval of 0.15 to 22.43 and P = 0.055 higher for the infected population. Hypertension was the most prevalent MetS sub-components, with diverse proportions of people living with HIV (5.2-50.0%) and uninfected (10.0-59.0%) populations.
CONCLUSIONS
The high range of MetS prevalence in the HIV-infected population compared to the uninfected population highlights the possible presence of HIV related drivers of MetS. Also, the reported high rate of MetS, irrespective of HIV status, indicates a major metabolic disorder epidemic that requires urgent prevention and management programs in SSA. Similarly, in the era of universal test and treat strategy among people living with HIV cohorts, routine check-up of MetS sub-components is required in HIV management as biomarkers.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42016045727.
背景
代谢综合征（MetS）是一组增加心血管疾病风险的病症。它是撒哈拉以南非洲（SSA）国家日益关注的问题，特别是由于人口日益老龄化和生活方式的改变。HIV 感染者中代谢综合征及其成分的风险增加；然而，SSA 人群中代谢综合征的流行程度及其 HIV 状态的差异贡献尚不清楚。本系统评价和荟萃分析旨在估计 HIV 感染者和未感染者中代谢综合征的总患病率，及其亚组分的变化。
方法
我们对主要数据库-MEDLINE（PubMed）、EBSCOhost 和 Cochrane 系统评价数据库和 Web of Sciences 进行了全面搜索，以查找比较 HIV 感染者和未感染者代谢综合征及其亚组分比例的原始流行病学研究文章，并于 1990 年 1 月至 2017 年 12 月发表。纳入标准为年龄≥18 岁的成年人，并有确诊的 HIV 感染状态。我们使用流行研究工具评估偏倚风险，并使用随机效应荟萃分析计算总患病率的汇总数据。
结果
共有四项横断面研究纳入了 496 名 HIV 未感染者和 731 名感染者的参与者，进行了荟萃分析。HIV 感染者中代谢综合征的总患病率为 21.5%（95% CI 15.09-26.86），未感染者为 12.0%（95% CI 5.00-21.00%），存在很大的异质性。两组之间代谢综合征的报告相对风险估计值为两倍（RR 1.83，95% CI 0.98-3.41），估计预测区间为 0.15 至 22.43，感染人群的 P 值为 0.055 更高。高血压是代谢综合征最常见的亚组分，HIV 感染者（5.2-50.0%）和未感染者（10.0-59.0%）的比例不同。
结论
与未感染者相比，HIV 感染者中代谢综合征的高患病率范围突出了 HIV 相关代谢综合征的可能存在。此外，无论 HIV 状态如何，报告的代谢综合征发生率都很高，表明在 SSA 需要紧急预防和管理计划的主要代谢障碍流行。同样，在 HIV 感染者队列中普遍进行检测和治疗策略的时代，在 HIV 管理中需要常规检查代谢综合征的亚组分作为生物标志物。
系统评价注册
PROSPERO CRD42016045727。
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