基于13755例过敏性紫癜患儿的肾脏损害危险因素的系统评价及Meta分析

发布时间：2018-05-15 04:40

本文选题：过敏性紫癜 + 肾脏损害　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:过敏性紫癜(Henoch-Sch?nlein purpura,HSP)是引起儿童慢性肾脏疾病的重要原因之一,通过系统评价及Meta分析方法明确其危险因素。方法:检索PubMed、Embase、Web of Science、中国知网、维普数据库、SinoMed,万方平台等数据库,采用Newcastle-Ottawa量表对纳入文献进行质量评价,采纳比值比和加权平均数计算效应量,并对纳入的危险因素进行分级。结果:共纳入59篇文献(13755名患儿),包含34项待分析的危险因素,其中18项危险因素与肾脏损害有相关性,危险因素9项包括:大年龄儿童(1.21,1.09-1.34),年龄大于10岁(2.25,1.41-3.59),腹痛(1.49,1.22-1.82),严重腹痛(3.68,1.91-7.10),消化道出血(2.23,1.85-2.68),持续性紫癜(2.92,1.81-4.71),皮疹反复(3.75,3.07-4.57),血小板升高(1.62,1.32-1.99),IgM升高(1.96,1.30-2.96);尚不确定的危险因素9项包括:农村籍(1.65,1.03-2.64),男性(1.40,1.06-1.86),白细胞升高(1.30,1.13-1.50),低白蛋白(2.62,-4.44,-0.81),胆固醇升高(0.79,0.64-0.94),血纤维蛋白原升高(2.28,1.53-3.38),尿微量蛋白升高(10.66,1.65-68.90),C3下降(1.74,1.11-2.72),Ig E升高(1.66,1.01-2.73),且城市籍儿童可能为肾脏损害的保护因素(0.47,0.29-0.77)。发病诱因、伴感染状态、食物过敏、发病季节、女性、关节症状、高血压、睾丸炎、血管神经性水肿、CRP升高、ESR升高、Ig A升高、幽门螺旋杆菌阳性与HSP患儿肾脏损害无显著相关。结论:大年龄儿童,大于10岁,腹痛,严重腹痛,消化道出血,持续性紫癜,皮疹反复,血小板升高,Ig M升高是过敏性紫癜肾脏损害的危险因素;针对肾脏损害的相关危险因素进行早期诊断干预有利于预后。此外,应根据本文的研究缺陷谨慎对待研究结果。
[Abstract]:Objective: Henoch-Schnlein purpura is one of the most important causes of chronic renal disease in children. The risk factors of Henoch-Schnlein purpura are identified by systematic evaluation and Meta analysis. Methods: the databases of PubMeden Embase of Science, China knowledge Network, Weip Database Sino Medand and Wanfang platform were searched. The quality of the literature was evaluated with Newcastle-Ottawa scale, the ratio and weighted average were adopted to calculate the effect quantity, and the risk factors were classified. Results: a total of 13755 children were included in 59 articles, including 34 risk factors to be analyzed, 18 of which were associated with renal damage. Nine risk factors are: 1.21U 1.09-1.34, older than 10 years old 2.251.1.41-3.59, abdominal pain 1.49.1.22-1.82, severe abdominal pain 3.681.91-7.10m, gastrointestinal bleeding 2.2321.85-2.68, persistent purpura 2.921.81-4.71, rash repeated 3.75n3.07-4.57, platelets 1.621.32-1.991.91.30-2.96; nine undetermined risk factors include: In rural areas, 1.400.6-1.86, 1.30U 1.13-1.50m, 2.62U -4.44U -0.81g, 0.79U 0.64-0.94g, 2.281.53-3.38C, 10.661.65-68.90C decreased 1.741.11-2.721.01-2.73g E, and 0.477n 0.29-0.771g E, which may be a protective factor for kidney damage in urban children. Inducement, infection status, food allergy, season, female, joint symptom, hypertension, orchitis, vascular and neuroedema CRP increased ESR and IgA increased. There was no significant correlation between Helicobacter pylori positive and renal damage in children with HSP. Conclusion: the risk factors of renal damage in Henoch-Schonlein purpura, persistent purpura, recurrent rash and elevated platelet level are abdominal pain, severe abdominal pain, gastrointestinal bleeding, and elevated platelet level in older children over 10 years old. Early diagnosis and intervention on risk factors related to renal damage is beneficial to prognosis. In addition, the research results should be treated with caution according to the shortcomings of this paper.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.5

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