血管紧张素转化酶抑制剂与老年人跌倒风险关系的Meta分析
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摘要
[目的]系统评价血管紧张素转化酶抑制剂(ACEI)与老年人跌倒的风险关系。[方法]系统检索PubMed,EMbase,CENTRAL,Elsevier和中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普、万方数据库,检索日期为建库至2017年12月,收集ACEI与老年人跌倒风险关系的病例对照研究和队列研究,采用纽卡斯尔-渥太华量表对纳入研究进行质量评价,应用RevMan 5. 3软件对提取数据进行Meta分析。[结果]纳入5项病例对照研究、6项队列研究,涉及69 870例病人。Meta分析结果:①对病例对照研究,未校正OR及校正OR的合并结果均表明ACEI会增加老年人跌倒的风险[未校正OR=1. 29,95%CI(1. 24,1. 36),P<0. 05;校正OR=1. 09,95%CI(1. 04,1. 14),P<0. 05];②对队列研究,未校正OR及校正OR的合并结果均表明ACEI不会增加老年人跌倒的风险[未校正OR=1. 03,95%CI(0. 79,1. 33),P=0. 84;校正OR=0. 98,95%CI(0. 86,1. 12),P=0. 77];③不同研究场所下和全面控制混杂因素下的Meta分析结果表明ACEI不会增加老年人跌倒的风险(P>0. 05)。[结论]基于队列研究的Meta分析结果以及不同研究场所和全面控制混杂因素分析结果提示ACEI不会增加老年人跌倒的风险,鉴于纳入研究的数量与质量的局限性,结果尚需未来更严谨的临床试验进一步验证。
Objective:To systematically evaluate the relationship between angiotensin-converting enzyme inhibitors(ACEI) and the risk for falls in the elderly.Methods:Case-control studies and cohort studies of relationship between ACEI and risk for falls in the elderly were retrieved from PubMed, EMbase, CENTRAL, Elsevier, China National Knowledge Infrastructure(CNKI), China Biomedical Literature Database(CBM),VIP Journal Integration Platform(VJIP),and Wanfang Database from the establishment to December 2017.The Newcastle-Ottawa Scale(NOS) were used for quality evaluation,and meta-analysis was performed by using RevMan 5.3 software.Results:A total of 5 case-control studies and 6 cohort studies were included,involving 69 870 patients.Meta-analysis results showed that:① in case-control studies, combined results of uncorrected OR and corrected OR showed that ACEI increased the risk for falls in the elderly[uncorrected OR=1.29,95% CI(1.24,1.36),P<0.05;corrected OR=1.09,95% CI(1.04,1.14),P<0.05];② in cohort studies,combined results of uncorrected OR and corrected OR showed that ACEI did not increase the risk for falls in the elderly [uncorrected OR=1.03, 95% CI(0.79, 1.33), P=0.84; corrected OR=0.98, 95% CI(0.86, 1.12), P=0.77]; ③ Meta-analysis results showed that ACEI would not increase the risk for falls in the elderly whether under different research locations or comprehensive controlled confounding factors(P>0.05).Conclusions:The results of the meta-analysis based on cohort study and the results of different research locations and comprehensive control of confounding factors suggest that ACEI does not increase the risk for falls in the elderly. In view of the limitations of the quantity and quality of the included studies,the results need further verified by more rigorous clinical trials.
Objective:To systematically evaluate the relationship between angiotensin-converting enzyme inhibitors(ACEI) and the risk for falls in the elderly.Methods:Case-control studies and cohort studies of relationship between ACEI and risk for falls in the elderly were retrieved from PubMed, EMbase, CENTRAL, Elsevier, China National Knowledge Infrastructure(CNKI), China Biomedical Literature Database(CBM),VIP Journal Integration Platform(VJIP),and Wanfang Database from the establishment to December 2017.The Newcastle-Ottawa Scale(NOS) were used for quality evaluation,and meta-analysis was performed by using RevMan 5.3 software.Results:A total of 5 case-control studies and 6 cohort studies were included,involving 69 870 patients.Meta-analysis results showed that:① in case-control studies, combined results of uncorrected OR and corrected OR showed that ACEI increased the risk for falls in the elderly[uncorrected OR=1.29,95% CI(1.24,1.36),P<0.05;corrected OR=1.09,95% CI(1.04,1.14),P<0.05];② in cohort studies,combined results of uncorrected OR and corrected OR showed that ACEI did not increase the risk for falls in the elderly [uncorrected OR=1.03, 95% CI(0.79, 1.33), P=0.84; corrected OR=0.98, 95% CI(0.86, 1.12), P=0.77]; ③ Meta-analysis results showed that ACEI would not increase the risk for falls in the elderly whether under different research locations or comprehensive controlled confounding factors(P>0.05).Conclusions:The results of the meta-analysis based on cohort study and the results of different research locations and comprehensive control of confounding factors suggest that ACEI does not increase the risk for falls in the elderly. In view of the limitations of the quantity and quality of the included studies,the results need further verified by more rigorous clinical trials.
引文
[1]于普林,覃朝晖,吴迪,等.北京城市社区老年人跌倒发生率的调查[J].中华老年医学杂志,2006,25(4):305-308.
[2]石婧,姚慧卿,陶永康,等.北京市社区老年人跌倒的发生率及相关因素的随访研究[J].中华老年医学杂志,2016,35(5):551-555.
[3]PRATO S C F,ANDRADE S M,CABRERA M S,et al.Frequency and factors associated with falls in adults aged 55 years or more[J].Rev Saude Publica,2017,51:37.
[4]SCHOENE D,DELBAERE K,LORD S R.Impaired response selection during stepping predicts falls in older people-a cohort study[J].J Am Med Dir Assoc,2017,18(8):719-725.
[5]Public Health England with the National Falls Prevention Coordination Group Member Organizations.Falls and fracture consensus statement supporting commissioning for prevention[R].London:Public Health England,2017:6.
[6]ALLISON L K,PAINTER J A,EMORY A,et al.Participation restriction,not fear of falling,predicts actual balance and mobility abilities in rural community-dwelling older adults[J].J Geriatr Phys Ther,2013,36(1):13-23.
[7]LEE J,GELLER A I,STRASSER D C.Analytical review:focus on fall screening assessments[J].PMR,2013,5(7):609-621.
[8]TOMITA Y,ARIMA K,TSUJIMOTO R,et al.Prevalence of fear of falling and associated factors among Japanese communitydwelling older adults[J].Medicine,2018,97(4):e9721.
[9]SCHEFFER A C,SCHUURMANS M J,VAN D N,et al.Fear of falling:measurement strategy,prevalence,risk factors and consequences among older persons[J].Age&Ageing,2008,37(1):19-24.
[10]ARFKEN C L,LACH H W,BIRGE S J,et al.The prevalence and correlates of fear of falling in elderly persons living in the community[J].American Journal of Public Health,1994,84(4):565-570.
[11]STEVENS J A,CORSO P S,FINKELSTEIN E A,et al.The costs of fatal and non-fatal falls among older adults[J].Injury Prevention Journal of the International Society for Child&Adolescent Injury Prevention,2006,12(5):290-295.
[12]HARTHOLT K A,POLINDER S,VAN DER CAMMEN T J,et al.Costs of falls in an ageing population:a nationwide study from the Netherlands(2007-2009)[J].Injury,2012,43(7):1199-1203.
[13]MAURER M S,BURCHAM J,CHENG H.Diabetes mellitus is associated with an increased risk of falls in elderly residents of a longterm care facility[J].Journals of Gerontology,2005,60(9):1157.
[14]MARCUM Z A,PERERA S,THORPE J M,et al.Anticholinergic use and recurrent falls in community-dwelling older adults:findings from the health ABC study[J].Journal of Gerontology,2015,70(12):1562.
[15]王淑云.高血压患者常见药物不良反应及合理用药分析[J].世界最新医学信息文摘,2018,18(11):115.
[16]徐朝飞.应用血管紧张素转换酶抑制剂不良反应的特征分析[J].中国循证心血管医学杂志,2017,9(8):969-971.
[17]HEITTERACHI E,LORD S R,MEYERKORT P,et al.Blood pressure changes on upright limb predict falls in older people[J].Age&Ageing,2002,31(3):181-186.
[18]HAM A C,SWART K M A,ENNEMAN A W,et al.Medication-related fall incidents in an older,ambulant population:the B-PROOF study[J].Drugs&Aging,2014,31(12):917.
[19]LIPSITZ L A,HABTEMARIAM D,GAGNON M,et al.Reexamining the effect of antihypertensive medications on falls in old age[J].Hypertension,2015,66(1):183-189.
[20]STANG A.Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in metaanalyses[J].Eur J Epidemiol,2010,25(9):603-605.
[21]DAVIES H T O,CROMBIE I K,TAVAKOLI M.When can odds ratios mislead?[J].BMJ Clinical Research,1998,316(7136):989-991.
[22]FISHER A A,MCLEAN A J,DAVIS M W,et al.A multicenter,case-control study of the effects of antihypertensive therapy on orthostatic hypotension,postprandial hypotension,and falls in Octo-and Nonagenarians in residential care facilities[J].Current Therapeutic Research Clinical&Experimental,2003,64(3):206-214.
[23]RHALIMI M,HELOU R,JAECKER P.Medication use and increased risk of falls in hospitalized elderly patients:a retrospective,case-control study[J].Drugs Aging,2009,26(10):847-852.
[24]GRIBBIN J,HUBBARD R,GLADMAN J R F,et al.Risk of falls associated with antihypertensive medication:population-based casecontrol study[J].Age and Ageing,2010,39(5):592-597.
[25]CHANG C M,CHEN M J,TSAI C Y,et al.Medical conditions and medications as risk factors of falls in the inpatient older people:a case-control study[J].International Journal of Geriatric Psychiatry,2011,26(6):602-607.
[26]ZIA A,KAMARUZZAMAN S B,MYINT P K,et al.The association of antihypertensives with postural blood pressure and falls among seniors residing in the community:a case-control study[J].European Journal of Clinical Investigation,2015,45(10):1069-1076.
[27]WONG A K,LORD S R,STURNIEKS D L,et al.Angiotensin system-blocking medications are associated with fewer falls over12 months in community-dwelling older people[J].Journal of the American Geriatrics Society,2013,61(5):776-781.
[28]CALLISAYA M L,SHARMAN J E,CLOSE J,et al.Greater daily defined dose of antihypertensive medication increases the risk of falls in older people--a population-based study[J].Journal of the American Geriatrics Society,2014,62(8):1527.
[29]STENHAGEN M,EKSTROM H,NORDELL E,et al.Falls in the general elderly population:a 3-and 6-year prospective study of risk factors using data from the longitudinal population study'Good ageing in Skane'[J].BMC Geriatr,2013,13:81.
[30]张天嵩,钟文昭,李博.实用循证医学方法学[M].2版.长沙:中南大学出版社,2014:344.
[31]罗杰,冷卫东.系统评价/Meta分析理论与实践[M].北京:军事医学科学出版社,2013:462.
[32]李立明,王建华.流行病学[M].3版.北京:人民卫生出版社,2015:106.
[2]石婧,姚慧卿,陶永康,等.北京市社区老年人跌倒的发生率及相关因素的随访研究[J].中华老年医学杂志,2016,35(5):551-555.
[3]PRATO S C F,ANDRADE S M,CABRERA M S,et al.Frequency and factors associated with falls in adults aged 55 years or more[J].Rev Saude Publica,2017,51:37.
[4]SCHOENE D,DELBAERE K,LORD S R.Impaired response selection during stepping predicts falls in older people-a cohort study[J].J Am Med Dir Assoc,2017,18(8):719-725.
[5]Public Health England with the National Falls Prevention Coordination Group Member Organizations.Falls and fracture consensus statement supporting commissioning for prevention[R].London:Public Health England,2017:6.
[6]ALLISON L K,PAINTER J A,EMORY A,et al.Participation restriction,not fear of falling,predicts actual balance and mobility abilities in rural community-dwelling older adults[J].J Geriatr Phys Ther,2013,36(1):13-23.
[7]LEE J,GELLER A I,STRASSER D C.Analytical review:focus on fall screening assessments[J].PMR,2013,5(7):609-621.
[8]TOMITA Y,ARIMA K,TSUJIMOTO R,et al.Prevalence of fear of falling and associated factors among Japanese communitydwelling older adults[J].Medicine,2018,97(4):e9721.
[9]SCHEFFER A C,SCHUURMANS M J,VAN D N,et al.Fear of falling:measurement strategy,prevalence,risk factors and consequences among older persons[J].Age&Ageing,2008,37(1):19-24.
[10]ARFKEN C L,LACH H W,BIRGE S J,et al.The prevalence and correlates of fear of falling in elderly persons living in the community[J].American Journal of Public Health,1994,84(4):565-570.
[11]STEVENS J A,CORSO P S,FINKELSTEIN E A,et al.The costs of fatal and non-fatal falls among older adults[J].Injury Prevention Journal of the International Society for Child&Adolescent Injury Prevention,2006,12(5):290-295.
[12]HARTHOLT K A,POLINDER S,VAN DER CAMMEN T J,et al.Costs of falls in an ageing population:a nationwide study from the Netherlands(2007-2009)[J].Injury,2012,43(7):1199-1203.
[13]MAURER M S,BURCHAM J,CHENG H.Diabetes mellitus is associated with an increased risk of falls in elderly residents of a longterm care facility[J].Journals of Gerontology,2005,60(9):1157.
[14]MARCUM Z A,PERERA S,THORPE J M,et al.Anticholinergic use and recurrent falls in community-dwelling older adults:findings from the health ABC study[J].Journal of Gerontology,2015,70(12):1562.
[15]王淑云.高血压患者常见药物不良反应及合理用药分析[J].世界最新医学信息文摘,2018,18(11):115.
[16]徐朝飞.应用血管紧张素转换酶抑制剂不良反应的特征分析[J].中国循证心血管医学杂志,2017,9(8):969-971.
[17]HEITTERACHI E,LORD S R,MEYERKORT P,et al.Blood pressure changes on upright limb predict falls in older people[J].Age&Ageing,2002,31(3):181-186.
[18]HAM A C,SWART K M A,ENNEMAN A W,et al.Medication-related fall incidents in an older,ambulant population:the B-PROOF study[J].Drugs&Aging,2014,31(12):917.
[19]LIPSITZ L A,HABTEMARIAM D,GAGNON M,et al.Reexamining the effect of antihypertensive medications on falls in old age[J].Hypertension,2015,66(1):183-189.
[20]STANG A.Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in metaanalyses[J].Eur J Epidemiol,2010,25(9):603-605.
[21]DAVIES H T O,CROMBIE I K,TAVAKOLI M.When can odds ratios mislead?[J].BMJ Clinical Research,1998,316(7136):989-991.
[22]FISHER A A,MCLEAN A J,DAVIS M W,et al.A multicenter,case-control study of the effects of antihypertensive therapy on orthostatic hypotension,postprandial hypotension,and falls in Octo-and Nonagenarians in residential care facilities[J].Current Therapeutic Research Clinical&Experimental,2003,64(3):206-214.
[23]RHALIMI M,HELOU R,JAECKER P.Medication use and increased risk of falls in hospitalized elderly patients:a retrospective,case-control study[J].Drugs Aging,2009,26(10):847-852.
[24]GRIBBIN J,HUBBARD R,GLADMAN J R F,et al.Risk of falls associated with antihypertensive medication:population-based casecontrol study[J].Age and Ageing,2010,39(5):592-597.
[25]CHANG C M,CHEN M J,TSAI C Y,et al.Medical conditions and medications as risk factors of falls in the inpatient older people:a case-control study[J].International Journal of Geriatric Psychiatry,2011,26(6):602-607.
[26]ZIA A,KAMARUZZAMAN S B,MYINT P K,et al.The association of antihypertensives with postural blood pressure and falls among seniors residing in the community:a case-control study[J].European Journal of Clinical Investigation,2015,45(10):1069-1076.
[27]WONG A K,LORD S R,STURNIEKS D L,et al.Angiotensin system-blocking medications are associated with fewer falls over12 months in community-dwelling older people[J].Journal of the American Geriatrics Society,2013,61(5):776-781.
[28]CALLISAYA M L,SHARMAN J E,CLOSE J,et al.Greater daily defined dose of antihypertensive medication increases the risk of falls in older people--a population-based study[J].Journal of the American Geriatrics Society,2014,62(8):1527.
[29]STENHAGEN M,EKSTROM H,NORDELL E,et al.Falls in the general elderly population:a 3-and 6-year prospective study of risk factors using data from the longitudinal population study'Good ageing in Skane'[J].BMC Geriatr,2013,13:81.
[30]张天嵩,钟文昭,李博.实用循证医学方法学[M].2版.长沙:中南大学出版社,2014:344.
[31]罗杰,冷卫东.系统评价/Meta分析理论与实践[M].北京:军事医学科学出版社,2013:462.
[32]李立明,王建华.流行病学[M].3版.北京:人民卫生出版社,2015:106.