Metaanalyse zur Bestimmung von Risikofaktoren für das Karpaltunnelsyndrom (KTS) Teil I. Allgemeine Risikofaktoren

Zusammenfassung

Studienziel: Durch den Sachverständigenrat Berufskrankheiten des Bundesministeriums für Arbeit und Soziales (BMAS) wurde das KTS (Karpaltunnelsyndrom) zur Aufnahme als Berufskrankheit (BK) empfohlen. Ziel der hier vorgestellten systematischen Literaturrecherche mit anschließender Metaanalyse war es, mit einem KTS assoziierte Faktoren und Riskofaktoren zu identifizieren. Dieser Teil beschreibt die außerberuflichen, allgemeinen Faktoren, die als konkurrierende Faktoren in späteren BK-Begutachtungsverfahren beachtet werden müssen. Methode: Zum Stichtag 15. 02. 2011 wurden aus den Datenbanken PubMed, Medline, Cochrane, EMBASE und Web of Science insgesamt 87 relevante Studien (27 Längsschnitt- und 60 Querschnittstudien) zum Einschluss in die Metaanalyse identifiziert. Die Metaanalyse berücksichtigte die PRISMA-(Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklisten. Die Berechnung der Effektstärken erfolgte im Random Effects Modell. Ergebnisse: Die Prävalenz des KTS in allen Studien unabhängig von der Studienpopulation betrug 10,6 % (95 %-KI 7,8–14,2), die Inzidenz 10,4/1000 (95 %-KI 8,9–11,9) Personenjahre. Als zur beruflichen Tätigkeit unabhängige, signifikante, mit einem KTS assoziierte Faktoren (Ergebnisse der Querschnittstudien) wurden ermittelt: höheres Lebensalter mit einem Gipfel im mittleren Lebensalter, weibliches Geschlecht, Übergewicht und Adipositas. Des Weiteren tritt das KTS häufiger an der dominanten Hand auf, Angehörige der „nicht weißen“ Rasse sind häufiger betroffen, und das KTS ist mit einer hohen Komorbidität vergesellschaftet. Die Auswertung der Längsschnittstudien erbrachte eine Reihe von Risikofaktoren für das KTS: Alter zwischen 40–60 Jahren, weibliches Geschlecht, Übergewicht und Adipositas, Diabetes mellitus und Alkoholabusus. Schlussfolgerungen: Das KTS ist eine ausgesprochen häufige Erkrankung. Bereits unterhalb einer BK-relevanten beruflichen Belastung (erheblich höherer Grad als die Normalbevölkerung) leiden viele Menschen unter diesem peripheren Nervenkompressionssyndrom. Die Kenntnis dieser Faktoren ist unabdingbar für spätere BK-Begutachtungen.

Abstract

Aim: The expert committee of the German Ministry for Labour and Social Affairs suggested carpal tunnel syndrome (CTS) as an “occupational disease”. This systematic literature review and metaanalysis was aimed at identifying associated and risk factors for CTS. Part I addresses the general factors and possible concurrent factors of CTS. These results may be helpful in later expertsʼ reviews of the “occupational disease CTS”. Methods: A systematic literature review was performed by examining papers in PubMed, Cochrane, EMBASE and Web of Science databases that were published on or before February 15th, 2011. A total of 87 studies (27 longitudinal and 60 cross-sectional) were included in this metaanalysis. The PRISMA (preferred reporting items for systematic reviews and metaanalyses) guidelines for performing a metaanalysis were strictly followed. All of the effect sizes were calculated using a random effects model. Results: The CTS prevalence in all studies independent of study type was 10.6 % (95 % CI 7.8–14.2). The crude incidence calculated from the longitudinal studies was 10.4 (95 % CI 8.9–11.9)/1000 person years. Female patients more frequently suffered from CTS [OR = 1.9 (95 % CI 1.6–2.2), p < 0.001]. The prevalence of CTS was correlated with an increase in age. The highest prevalence was observed in middle-aged patients (40 to 60 years old). Other significant CTS-associated factors were overweight or obesity [OR = 1.4 (95 % CI 1.3–1.6), p < 0.001]. CTS more frequently occurred in the dominant hand [OR = 1.8 (95 % CI 1.4–2.3), p < 0.001] and in persons of “non-white race” [OR = 1.6 (95 % CI 1.2–1.9), p < 0.001]. Furthermore, CTS was often associated with numerous other general diseases. Real risk factors (results from longitudinal studies) were the following: female gender [OR = 3.7 (95 % CI 2.6–5.2), p < 0.001], middle age [OR = 2.2 (95 % CI 0.9–4.9), p < 0.001], overweight or obesity [OR = 1.5 (95 % CI 1.1–1.9), p < 0.001], diabetes mellitus [OR = 5.3 (95 % CI 1.6–16.8), p < 0.001], and excessive alcohol abuse [OR = 2.3 (95 % CI 0.7–2.3), p < 0.001]. Conclusion: CTS is an extremely frequent disease. Independent of occupational burden, many patients are suffering from this frequent peripheral nervous compressive syndrome. These data will be essential in later expertsʼ reviews of the “occupational disease CTS”.

Schlüsselwörter

KTS - Hand - Risiko - Metaanalyse

Key words

CTS - hand - risk - metaanalysis

• Literatur

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