糖尿病与帕金森病发病风险的Meta分析

A Meta-analysis of association between diabetes mellitus and the risk of Parkinson’s disease

摘要:

目的：糖尿病(diabetes，DM)与帕金森病（Parkinson’s disease，PD）的风险关系目前尚无结论，本文对两者之间的关系进行系统评价。方法：检索PubMed，中国知网，万方，维普数据库中2016年3月之前发表的文献。查找PD与DM相关的病例对照研究，提取相关数据，通过Review Manager 5.3软件分别进行数据的分析。结果：筛选出符合要求的文献共7篇，共纳入PD患者5143例，对照组5713例，通过数据处理发现尽管结果异质性较高(I2=76%，P＜0.010)，结果提示糖尿病的个人发病率与其后期PD发生率呈负相关（OR=0.62，95%CI=0.41～0.94)。考虑数据结果异质性较高，我们以PD诊断的平均年龄及吸烟史进行了亚组分析。结果显示，PD年龄≤67.2岁（OR=0.35，95% CI=0.21～0.59），年龄＞67.2岁(OR=0.69，95%CI=0.38～1.24)；有吸烟史组（OR=0.56，95%CI=0.33～0.94），无吸烟史组（OR=0.74，95%CI=0.27～1.99）。另外，我们通过敏感分析再次证实该结果的可靠性。结论：尽管数据结果有明显的异质性，本研究数据结果提示DM可能降低PD的发病率，我们需要进一步研究两者共同发病机制并且相互作用的共同致病因素来证明DM与PD之间的关系。

Abstract:

Objective: To systematically review the association between diabetes mellitus (DM) and the risk of Parkinson’s disease (PD). Methods: PubMed, CNKI, Wanfang Data, and VIP were searched for related articles published up to March 2016. Case-control studies on PD and DM were retrieved, related data were extracted, and Review Manager 5.3 was used for data analysis. Results: Seven articles which met the inclusion criteria were included in the meta-analysis, with a total of 5143 PD patients and 5713 controls. Data processing showed that in spite of significant heterogeneity (I2 = 76%, P <0.010), the incidence rate of diabetes was negatively correlated with the incidence rate of PD [odds ratio (OR)=0.62, 95% confidence interval(CI)=0.41 to 0.94]. Due to significant heterogeneity in data, subgroup analysis was performed based on the mean age at the time of PD diagnosis and smoking history, and the results showed that for PD in patients aged ≤67.2 years（OR=0.35，95% CI=0.21 to 0.59）, in patients aged >67.2 years(OR=0.69，95%CI=0.38 to 1.24), and in patients with a history of smoking（OR=0.56，95%CI=0.33 to 0.94） and in patients without a history of smoking（OR=0.74，95%CI=0.27 to 1.99）. In addition, the sensitivity analysis confirmed the reliability of the above results. Conclusion: The results of the case-control studies suggest that DM may reduce the incidence rate of PD despite of significant heterogeneity. Further studies focusing on the common pathogenesis of DM and PD and the pathogenic factors interacting with one another are needed to investigate the association between DM and PD.