背景:关于糖尿病(DM)是否会对因颈动脉狭窄而接受颈动脉内膜切除术(CEA)的患者产生不利影响,仍存在不确定性。该研究的目的是评估DM对CEA治疗的颈动脉狭窄患者的不利影响。
方法:2000年1月1日至2023年3月30日之间发表的合格研究来自PubMed,EMBASE,WebofScience,中部,和临床试验数据库。主要不良事件(MAE)的短期和长期结果,死亡,中风,死亡/中风的复合结局,收集心肌梗死(MI)来计算合并效应大小(ESs),95%置信区间(CI),和不良后果的患病率。通过无症状/有症状的颈动脉狭窄和胰岛素/非胰岛素依赖性DM进行亚组分析。
结果:共纳入19项研究(n=122,003)。关于短期结果,DM与MAE风险增加相关(ES=1.52,95%CI:[1.15-2.01],患病率=5.1%),死亡/中风(ES=1.61,95%CI:[1.13-2.28],患病率=2.3%),中风(ES=1.55,95%CI:[1.16-1.55],患病率=3.5%),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%)。DM与长期MAE风险增加相关(ES=1.24,95%CI:[1.04-1.49],患病率=12.2%)。在亚组分析中,DM与短期MAE的风险增加有关,死亡/中风,中风,无症状患者接受CEA和仅有短期MAE的MI。胰岛素依赖型和非胰岛素依赖型DM患者短期和长期MAE的风险均增加,胰岛素依赖型糖尿病也与死亡/卒中的短期风险相关,死亡,还有MI。
结论: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有较大影响。与非胰岛素依赖型DM相比,胰岛素依赖型DM对CEA后不良结局的影响更大。DM管理是否可以降低CEA后不良后果的风险需要进一步调查。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.