糖尿病患者外周动脉疾病患者对体育锻炼和饮食治疗反应的特征：一项系统综述。
完整摘要 · 中文译文
目的：外周动脉疾病（PAD）影响步行能力并增加截肢风险。糖尿病（DM）不仅促进疾病进展，还可能影响治疗效果。尽管体育锻炼在PAD管理中至关重要，且饮食优化可能降低动脉粥样硬化风险，但其在糖尿病PAD患者中的效果及差异仍不明确。本系统综述旨在总结糖尿病PAD患者对体育锻炼和饮食管理治疗反应的特征，并为临床实践中优化此类患者的PAD管理提供关键信息。 方法：通过检索PubMed、Embase、Scopus、Web of Science和CINAHL，对研究体育锻炼和饮食对糖尿病PAD患者疾病发展和改善效果的人体研究进行系统综述。本综述按照系统综述和荟萃分析优先报告条目（PRISMA）进行。证据确定性水平采用推荐分级的评估、制定与评价（GRADE）进行评估。 结果：共纳入18项研究，其中15项评估运动对糖尿病PAD的影响，3项评估饮食与糖尿病PAD的相关性。监督下运动治疗（SET）和居家运动能够改善糖尿病PAD患者的踝肱指数（ABI）和血流速度。相反，步行能力如六分钟步行距离（6MWD）、最大步行时间和距离、峰值步行时间（PWT）以及跛行起始 时间（COT）未见显著改善或呈现相互矛盾的结果。进行多种运动或替代性干预（如冲击波治疗或低频脉冲电磁场治疗（LFPMT））可能增强ABI的改善。坚持地中海饮食与血流和间歇性跛行以及发生PAD的风险相关。GRADE分析显示，关于ABI、血流速度和功能的发现证据等级为极低至中等，主要归因于研究类型、可用研究数量、样本量小、中等偏倚风险以及结果相互矛盾。同样，由于研究类型和可用研究数量，饮食对PAD风险的影响和关联的证据等级也被显示为低。 结论：糖尿病PAD患者在步行表现和其他功能方面可能对体育锻炼的治疗反应降低，而通过结合多种体育锻炼或替代性干预（联合或不联合运动）可能有所改善。地中海饮食可能具有有益效应，尚需进一步研究。这些发现的确定性水平为极低至中等，因此，未来有必要进一步验证。
完整摘要 · 英文原文
PURPOSE: Peripheral artery disease (PAD) affects walking performance and increases risk of amputation. Diabetes mellitus (DM) not only contributes to disease progression but may also affect treatment effects. Though physical exercise is crucial in PAD management and diet optimization may reduce risk of atherosclerosis, their effects and variations in diabetic PAD patients remain unclear. The present systematic review aims to summarize features of treatment response to physical exercise and diet management in diabetic PAD patients, and provide crucial information on optimization of PAD management of these patients in clinical practice. METHODS: A systematic review was performed on human studies investigating effects of physical exercise and diet on development and improvement of diabetic PAD patients by searching PubMed, Embase, Scopus, Web of Science and CINAHL. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The certainty level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS: A total of 18 studies were included, 15 of which evaluated effects of exercise on diabetic PAD, and three evaluated correlation between diet and diabetic PAD. Supervised exercise therapy (SET) and home-based exercise were able to improve ankle-brachial index (ABI) and blood flow velocity in diabetic PAD. In contrast, walking performance such as the six minute walk distance (6MWD), maximal walking time and distance, peak walking time (PWT) and claudication onset time (COT) were not significantly improved or presented conflicting results. Administration of multiple exercises or alternative interventions such as shock wave therapy or low-frequency pulsed electromagnetic field therapy (LFPMT) may enhance improvement of ABI. Adherence to Mediterranean diet was associated with blood flow and intermittent claudication, as well as risk of development of PAD. GRADE analysis revealed very low to moderate grade evidence for findings on ABI, flow velocity and functions, mainly due to study types, number of studies available, small sample size, moderate risk of bias and conflicting results. Similarly, low grade evidence was also revealed for effects and association of diet on risk of PAD due to study type and number of studies available. CONCLUSION: Diabetic PAD patients may present reduced treatment response to physical exercise in walking performance and other functions, which may be improved by combination of multiple physical exercises or alternative interventions with or without combination of exercise. Mediterranean diet may be associated with beneficial effects, which requires further investigations. These findings were of very low to moderate level of certainty, and therefore, further validation is warranted in the future.