屈光不正与糖尿病视网膜病变风险之间的关系：一项系统评价和荟萃分析。
The relationship between refractive error and the risk of diabetic retinopathy: a systematic review and meta-analysis.
作者信息
Li Yanqing, Hu Pengcheng, Li Li, Wu Xianhui, Wang Xi, Peng Yanli
机构信息
Department of Refractive Surgery, China Aier Eye Hospital Group, Chongqing Aier Eye Hospital, Chongqing, China.
Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Front Med (Lausanne). 2024 Jun 4;11:1354856. doi: 10.3389/fmed.2024.1354856. eCollection 2024.
PURPOSE
This meta-analysis was conducted to collect all available data and estimate the relationship between refractive error and the risk of diabetic retinopathy (DR) in patients with diabetes, and to assess whether vision-threatening DR (VTDR) is associated with refractive error.
METHODS
We systematically searched several literature databases including PubMed, Embase, Cochrane Library, Web of Science, CNKI, CBM, Wan Fang Data, and VIP databases. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using fixed or random effects models. Four models were developed to assess the relationship between refractive error and the risk and DR, VTDR: hyperopia and DR, VTDR; myopia and DR, VTDR; spherical equivalent (SE per D increase) and DR, VTDR; and axial length (AL per mm increase) and DR, VTDR. The included literature was meta-analyzed using Stata 12.0 software, and sensitivity analysis was performed. Publication bias in the literature was evaluated using a funnel plot, Begg's test, and Egger's test.
RESULTS
A systematic search identified 3,198 articles, of which 21 (4 cohorts, 17 cross-sectional studies) were included in the meta-analysis. Meta-analysis showed that hyperopia was associated with an increased risk of VTDR ( 1.23; 95% : 1.08-1.39; = 0.001), but not with DR ( 1.05; 95% : 0.94-1.17; = 0.374). Myopia was associated with a reduced risk of DR ( 0.74; 95% : 0.61-0.90; = 0.003), but not with VTDR ( 1.08; 95% : 0.85-1.38; = 0.519). Every 1 diopter increase in spherical equivalent, there was a 1.08 increase in the odds ratio of DR ( 1.08; 95% : 1.05-1.10; <0.001), but not with VTDR ( 1.05; 95% : 1.00-1.10; = 0.06). AL per mm increase was significantly associated with a decreased risk of developing DR ( 0.77; 95% : 0.71-0.84; <0.001 and VTDR ( 0.63; 95% : 0.56-0.72; <0.001). Analysis of sensitivity confirmed the reliability of the study's findings.
CONCLUSION
This meta-analysis demonstrates hyperopia was associated with an increased risk of VTDR in diabetes patients. Myopia was associated with a reduced risk of DR. AL is an important influencing factor of refractive error. Every 1 mm increase in AL reduces the risk of DR by 23% and the risk of VTDR by 37%.
SYSTEMATIC REVIEW REGISTRATION
identifier: CRD42023413420.
目的
本荟萃分析旨在收集所有可用数据，评估糖尿病患者屈光不正与糖尿病视网膜病变（DR）风险之间的关系，并评估威胁视力的DR（VTDR）是否与屈光不正相关。
方法
我们系统检索了多个文献数据库，包括PubMed、Embase、Cochrane图书馆、Web of Science、中国知网、中国生物医学文献数据库、万方数据和维普数据库。使用固定效应或随机效应模型计算合并比值比（OR）和95%置信区间（CI）。建立了四个模型来评估屈光不正与DR、VTDR风险之间的关系：远视与DR、VTDR；近视与DR、VTDR；等效球镜度（每增加1 D）与DR、VTDR；眼轴长度（每增加1 mm）与DR、VTDR。使用Stata 12.0软件对纳入的文献进行荟萃分析，并进行敏感性分析。使用漏斗图、Begg检验和Egger检验评估文献中的发表偏倚。
结果
系统检索共识别出3198篇文章，其中21篇（4个队列研究，17个横断面研究）纳入荟萃分析。荟萃分析显示，远视与VTDR风险增加相关（OR = 1.23；95%CI：1.08 - 1.39；P = 0.001），但与DR无关（OR = 1.05；95%CI：0.94 - 1.17；P = 0.374）。近视与DR风险降低相关（OR = 0.74；95%CI：0.61 - 0.90；P = 0.003），但与VTDR无关（OR = 1.08；95%CI：0.85 - 1.38；P = 0.519）。等效球镜度每增加1屈光度，DR的比值比增加1.08（OR = 1.08；95%CI：1.05 - 1.10；P < 0.001），但与VTDR无关（OR = 1.05；95%CI：1.00 - 1.10；P = 0.06）。眼轴长度每增加1 mm与DR发生风险显著降低相关（OR = 0.77；95%CI：0.71 - 0.84；P < 0.001）以及VTDR（OR = 0.63；95%CI：0.56 - 0.72；P < 0.001）。敏感性分析证实了研究结果的可靠性。
结论
本荟萃分析表明，远视与糖尿病患者VTDR风险增加相关。近视与DR风险降低相关。眼轴长度是屈光不正的重要影响因素。眼轴长度每增加1 mm，DR风险降低23%，VTDR风险降低37%。
系统评价注册
标识符：CRD42023413420。
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