男性糖尿病与腹主动脉瘤的相关性：两项丹麦筛查研究、系统评价和基于人群的筛查研究荟萃分析的结果。
The association between diabetes and abdominal aortic aneurysms in men: results of two Danish screening studies, a systematic review, and a meta-analysis of population-based screening studies.
机构信息
Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
The Danish Diabetes Academy, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark.
出版信息
BMC Cardiovasc Disord. 2023 Mar 16;23(1):139. doi: 10.1186/s12872-023-03160-8.
BACKGROUND
A paradoxical protective effect of diabetes on the development and progression of abdominal aortic aneurysms (AAA) has been known for years. This study aimed to investigate whether the protective role of diabetes on AAAs has evolved over the years.
METHODS
A cross-sectional study, a systematic review and meta-analysis. This study was based on two large, population-based, randomised screening trials of men aged 65-74; VIVA (2008-2011) and DANCAVAS (2014-2018), including measurement of the abdominal aorta by ultrasound or CT, respectively. Analyses were performed using multiple logistic regressions to estimate the odds ratios (ORs) for AAAs in men with diabetes compared to those not having diabetes. Moreover, a systematic review and meta-analysis of population-based screening studies of AAAs to visualise a potential change of the association between diabetes and AAAs. Studies reporting only on women or Asian populations were excluded.
RESULTS
In VIVA, the prevalence of AAA was 3.3%, crude OR for AAA in men with diabetes 1.04 (95% confidence interval, CI, 0.80-1.34), and adjusted OR 0.64 (CI 0.48-0.84). In DANCAVAS, the prevalence of AAA was 4.2%, crude OR 1.44 (CI 1.11-1.87), and adjusted OR 0.78 (CI 0.59-1.04). Twenty-three studies were identified for the meta-analysis (N = 224 766). The overall crude OR was 0.90 (CI 0.77-1.05) before 2000 and 1.16 (CI 1.03-1.30) after 1999. The overall adjusted OR was 0.63 (CI 0.59-0.69) before 2000 and 0.69 (CI 0.57-0.84) after 1999.
CONCLUSION
Both the crude and adjusted OR showed a statistically non-significant trend towards an increased risk of AAA by the presence of diabetes. If this represents an actual trend, it could be due to a change in the diabetes population.
TRIAL REGISTRATION
DANCAVAS: Current Controlled Trials: ISRCTN12157806. VIVA: ClinicalTrials.gov NCT00662480.
背景
多年来，糖尿病对腹主动脉瘤（AAA）的发展和进展的矛盾保护作用已为人所知。本研究旨在探讨糖尿病对 AAA 的保护作用是否随着时间的推移而发生了变化。
方法
本研究为一项横断面研究、系统评价和荟萃分析。该研究基于两项大型、基于人群的、针对 65-74 岁男性的随机筛查试验；VIVA（2008-2011 年）和 DANCAVAS（2014-2018 年），分别通过超声或 CT 测量腹主动脉。使用多因素逻辑回归分析来估计患有糖尿病的男性与未患有糖尿病的男性相比，AAA 的优势比（OR）。此外，还对 AAA 的基于人群的筛查研究进行了系统评价和荟萃分析，以观察糖尿病与 AAA 之间关联的潜在变化。排除仅报告女性或亚洲人群的研究。
结果
在 VIVA 中，AAA 的患病率为 3.3%，糖尿病男性患 AAA 的粗 OR 为 1.04（95%置信区间，CI，0.80-1.34），调整后 OR 为 0.64（CI 0.48-0.84）。在 DANCAVAS 中，AAA 的患病率为 4.2%，粗 OR 为 1.44（CI 1.11-1.87），调整后 OR 为 0.78（CI 0.59-1.04）。确定了 23 项用于荟萃分析的研究（N=224766）。总体粗 OR 在 2000 年之前为 0.90（CI 0.77-1.05），在 1999 年之后为 1.16（CI 1.03-1.30）。总体调整后 OR 在 2000 年之前为 0.63（CI 0.59-0.69），在 1999 年之后为 0.69（CI 0.57-0.84）。
结论
无论是粗 OR 还是调整后 OR，均显示出糖尿病存在与 AAA 风险增加之间存在统计学上无显著意义的趋势。如果这代表了实际趋势，那可能是由于糖尿病人群的变化所致。
试验注册
DANCAVAS：当前对照试验：ISRCTN81232162。VIVA：ClinicalTrials.gov NCT00662480。
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