本文選題：2型糖尿病　切入點：阻塞性睡眠呼吸暫停綜合征　出處：《大連醫(yī)科大學》2013年碩士論文　論文類型：學位論文

【摘要】：目的：阻塞性睡眠呼吸暫停綜合征（OSAS）在成年人群中是一種常見的疾病。OSAS患者中血糖代謝紊亂更常見，提示OSAS可能會加劇糖尿病患者的血糖代謝紊亂狀態(tài)。連續(xù)氣道正壓通氣（CPAP）是OSAS治療的首選方式，也有可能對糖尿病患者血糖代謝有幫助。為此，我們選取已發(fā)表的隨機對照試驗進行薈萃分析，系統(tǒng)評估CPAP對OSAS合并2型糖尿�。═2DM）患者在血糖控制等方面的影響。 方法：我們搜索了PubMed、EMBASE數(shù)據(jù)庫，中文的維普及CNKI數(shù)據(jù)庫。從建庫直到2013年3月，檢索所有發(fā)表的關于OSAS和T2DM關系的研究，選取CPAP對T2DM患者的代謝方面影響的隨機對照試驗。入選標準：（1）公開發(fā)表的中英文文獻，數(shù)據(jù)資料完整；（2）研究OSAS合并T2DM成年患者，，沒有種族、性別限制；（3）隨機對照試驗，不考慮分配隱藏或盲法；（4）干預措施：CPAP治療作為治療組，非特異治療作為對照組；（5）評價結(jié)果：糖化血紅蛋白（HbA1c）、空腹血糖(FBG)、餐后血糖（PBG）、胰島素抵抗指數(shù)(HOMA-IR)、體重指數(shù)(BMI)和其他代謝指標，以及睡眠呼吸暫停低通氣指數(shù)(AHI)、最低血氧飽和度(LSPO2)、愛普沃斯嗜睡量表評分(ESS)等呼吸相關指標也包括在內(nèi)。排除標準：僅以摘要發(fā)表、非隨機對照研究、以及重復發(fā)表或未公開發(fā)表、數(shù)據(jù)不全的文獻。進行初步篩選，兩名研究者獨自閱讀所檢索到文獻的題目和摘要，分別根據(jù)入選及剔除標準選擇合格的文獻，采用統(tǒng)一的表格提取資料，利用Google和其他搜索引擎在互聯(lián)網(wǎng)上查找相關的文獻。對于缺乏的數(shù)據(jù)，通過電子郵件與作者取得聯(lián)系。收集的信息包括作者的姓名，出版年份，研究地區(qū)和研究人群，干預措施，兩組患者的基本特征，研究時間和效應指標等。英文文獻以HbA1c，BMI，ESS的均值和標準差作為效應指標。中文文獻以HbA1c，F(xiàn)BG，PBG，HOMA-IR，BMI，ESS，AHI，LSPO2的均值和標準差作為效應指標。對最終納入的中英文文獻，使用JADAD量表進行質(zhì)量評價。采用Review Manager5.1軟件進行薈萃分析。中英文薈萃結(jié)果分別列出。 結(jié)果：共查詢了586篇相關研究，排除文獻包括51篇重復和未公開發(fā)表，19篇干預措施不符合，76篇數(shù)據(jù)不全，118篇僅以摘要發(fā)表，297篇非隨機對照試驗。選取了17篇流行病學調(diào)查相關研究參與進行系統(tǒng)回顧。共納入8篇隨機對照試驗進行薈萃分析，包括330例OSAS合并T2DM患者。3篇英文研究薈萃結(jié)果分析顯示：CPAP治療后改善了ESS情況，[WMD=-6.33，95%CI：（-9.01，-3.66），P0.00001]，差異有統(tǒng)計學意義。對HbA1c水平[WMD=-0.12，95%CI：（-0.86，0.62），P=0.75]及BMI[WMD=-0.62，95%CI：（-2.40，1.16），P=0.49]方面的影響，雖然可見似乎略有下降，但以治療前后差值作比較，效應量無統(tǒng)計學意義。5篇中文研究的薈萃分析顯示：CPAP治療組與對照組在HbA1c[WMD=-0.50，95%CI：（-0.72，-0.28），P0.00001]、 FBG[WMD=-1.19，95%CI：（-1.52，-0.87）， P0.00001]、PBG[WMD=-1.02，95%CI：（-1.43，-0.62），P0.00001]方面的差異有統(tǒng)計學意義；在HOMA-IR[WMD=-1.80，95%CI：（-4.64，1.04），P=0.21]、BMI[WMD=-0.69，95%CI：（-1.79，0.41）， P=0.22]方面差異無統(tǒng)計學意義。 CPAP可提高LSPO2[WMD=24.04，95%CI：（20.04，28.05），P0.00001]，但對患者的AHI無改善[WMD=-23.65，95%CI：（-51.24，3.93），P=0.09]。 結(jié)論：對于合并OSAS的T2DM患者，CPAP治療改善LSPO2及血糖控制，但仍需要大規(guī)模的研究進一步證實。
[Abstract]:Objective: obstructive sleep apnea syndrome (OSAS) in adults is a common disease of glucose metabolism in patients with.OSAS disorders are more common, suggesting that OSAS may exacerbate the disorder of glucose metabolism in diabetic patients. Continuous positive airway pressure (CPAP) is the preferred way to OSAS treatment, there may be help on glucose metabolism in diabetic patients. Therefore, we selected randomized controlled trials published meta-analysis, CPAP system evaluation of OSAS patients with type 2 diabetes mellitus (T2DM) patients in control of blood sugar.
Methods: We searched the PubMed EMBASE database, the CNKI database and VIP Chinese. From inception until March 2013, all published on OSAS and T2DM to study the relationship between the retrieval of randomized controlled trials to select the metabolism of CPAP in patients with T2DM. The influence of inclusion criteria: (1) published in the English literature data; (2) study of OSAS combined T2DM adult patients, there is no racial, gender restrictions; (3) randomized controlled trials, regardless of allocation concealment or blind method; (4) intervention: CPAP treatment as treatment group and non specific treatment as the control group; (5) evaluation results: glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PBG), insulin resistance index (HOMA-IR), body mass index (BMI) and other metabolic indexes, and sleep apnea hypopnea index (AHI), the lowest oxygen saturation (LSPO2), SAP Voss sleepiness score (ES S) respiratory related indicators are also included. Exclusion criteria: published only in abstract, non randomized studies, and repeated published or unpublished literature, incomplete data. Preliminary screening, two researchers reading alone retrieved literature titles and abstracts, respectively according to the inclusion and exclusion criteria to select qualified the literature, form a unified data extraction, using Google and other search engines on the Internet to find relevant documents. For the lack of data, contact by email with the author. The collected information including the author's name, year of publication, research area and intervention study population, the basic characteristics of the two groups of patients. Study on time and effect index. English literature by HbA1c, BMI, ESS mean and standard deviation as the effect indicators. Chinese literature by HbA1c, FBG, PBG, HOMA-IR, BMI, ESS, AHI, mean and standard LSPO2 JADAD Review was used to evaluate the quality of the final Chinese and English literatures. Meta analysis was conducted by using Manager5.1 software.
Results: a total of 586 query related studies, including 51 articles excluded studies repeated and unpublished, 19 intervention measures do not meet, 76 incomplete data, 118 articles published 297 articles only in the abstract, non randomized controlled trials. Selects 17 pieces of epidemiological investigation involved in related research system were included in the review. 8 randomized controlled trials for meta-analysis, including 330 cases of.3 patients with OSAS T2DM English of meta analysis showed that: after CPAP treatment improved the ESS, [WMD=-6.33,95%CI: (-9.01, -3.66), P0.00001], the difference was statistically significant. [WMD=-0.12,95%CI: on the level of HbA1c (-0.86,0.62), P=0.75] and BMI[WMD=-0.62,95%CI: (-2.40,1.16), P=0.49] although the visible seems to decline slightly, but the difference between before and after treatment to compare effect was not statistically significant.5 Chinese meta-analysis of studies showed that CPAP treatment group and the In the HbA1c[WMD=-0.50,95%CI: control group (-0.72, -0.28), P0.00001], FBG[WMD=-1.19,95%CI: (-1.52, -0.87), P0.00001], PBG[WMD=-1.02,95%CI: (-1.43, -0.62), there was significant difference in the P0.00001]; HOMA-IR[WMD=-1.80,95%CI: (-4.64,1.04), P =0.21], BMI[WMD=-0.69,95%CI: (-1.79,0.41), no statistically significant differences. P=0.22] CPAP can improve LSPO2[WMD=24.04,95%CI: (20.04,28.05) P0.00001], but no improvement in patients with [WMD=-23.65,95%CI: AHI (-51.24,3.93), P=0.09].
Conclusion: for patients with T2DM combined with OSAS, CPAP treatment improves LSPO2 and blood glucose control, but a large-scale study is still needed to be further confirmed.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R766;R587.1

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