Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Department of Breast Oncoplastic Surgery, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410031, China.
Chin Med J (Engl). 2023 Jun 20;136(12):1401-1409. doi: 10.1097/CM9.0000000000002730. Epub 2023 May 22.
There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA.
Eligible studies published between 1 January 2000 and 30 March 2023 were selected from the PubMed, EMBASE, Web of Science, CENTRAL, and ClinicalTrials databases. The short-term and long-term outcomes of major adverse events (MAEs), death, stroke, the composite outcomes of death/stroke, and myocardial infarction (MI) were collected to calculate the pooled effect sizes (ESs), 95% confidence intervals (CIs), and prevalence of adverse outcomes. Subgroup analysis by asymptomatic/symptomatic carotid stenosis and insulin/noninsulin-dependent DM was performed.
A total of 19 studies (n = 122,003) were included. Regarding the short-term outcomes, DM was associated with increased risks of MAEs (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 5.1%), death/stroke (ES = 1.61, 95% CI: [1.13-2.28], prevalence = 2.3%), stroke (ES = 1.55, 95% CI: [1.16-1.55], prevalence = 3.5%), death (ES = 1.70, 95% CI: [1.25-2.31], prevalence =1.2%), and MI (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 1.4%). DM was associated with increased risks of long-term MAEs (ES = 1.24, 95% CI: [1.04-1.49], prevalence = 12.2%). In the subgroup analysis, DM was associated with an increased risk of short-term MAEs, death/stroke, stroke, and MI in asymptomatic patients undergoing CEA and with only short-term MAEs in the symptomatic patients. Both insulin- and noninsulin-dependent DM patients had an increased risk of short-term and long-term MAEs, and insulin-dependent DM was also associated with the short-term risk of death/stroke, death, and MI.
In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation.
糖尿病（DM）是否会对颈动脉狭窄行颈动脉内膜切除术（CEA）的患者产生不良影响仍存在不确定性。本研究旨在评估 DM 对接受 CEA 治疗的颈动脉狭窄患者的不良影响。
从 PubMed、EMBASE、Web of Science、CENTRAL 和 ClinicalTrials 数据库中选取 2000 年 1 月 1 日至 2023 年 3 月 30 日发表的符合条件的研究。收集主要不良事件（MAE）、死亡、卒中和死亡/卒中等复合结局以及心肌梗死（MI）的短期和长期结局，以计算汇总效应量（ES）、95%置信区间（CI）和不良结局的患病率。对无症状/有症状颈动脉狭窄和胰岛素/非胰岛素依赖性 DM 进行亚组分析。
共纳入 19 项研究（n = 122003 例）。关于短期结局，DM 与 MAE（ES = 1.52，95%CI：[1.15-2.01]，患病率 = 5.1%）、死亡/卒中和卒中（ES = 1.61，95%CI：[1.13-2.28]，患病率 = 2.3%）、卒中和死亡（ES = 1.70，95%CI：[1.25-2.31]，患病率 = 1.2%）和 MI（ES = 1.52，95%CI：[1.15-2.01]，患病率 = 1.4%）的风险增加相关。DM 与长期 MAE（ES = 1.24，95%CI：[1.04-1.49]，患病率 = 12.2%）风险增加相关。在亚组分析中，DM 与无症状患者 CEA 后短期 MAE、死亡/卒中和卒中以及 MI 的风险增加相关，而在有症状患者中仅与短期 MAE 风险增加相关。胰岛素依赖性和非胰岛素依赖性 DM 患者的短期和长期 MAE 风险均增加，胰岛素依赖性 DM 与 CEA 后短期死亡/卒中和死亡以及 MI 的风险增加也相关。
在接受 CEA 治疗的颈动脉狭窄患者中，DM 与短期和长期 MAE 相关。DM 可能对 CEA 后无症状患者的不良结局产生更大影响。与非胰岛素依赖性 DM 相比，胰岛素依赖性 DM 对 CEA 后不良结局的影响可能更为显著。DM 管理是否能降低 CEA 后不良结局的风险，需要进一步研究。
