过敏性紫癜患儿并发肾脏损害高危因素的Meta分析

发布时间：2018-05-23 14:32

本文选题：过敏性紫癜 + 肾脏损害　；参考：《山东大学》2012年硕士论文

【摘要】：研究背景过敏性紫癜(anaphylactoid purpura)又称亨-舒综合症(Henoch-Schonlein syndrome, Henoch-Schonlein purpura, HSP)是儿童时期最常见的一种以小血管炎为主要病变的系统性血管炎。临床特点主要为血小板不减少性皮肤紫癜,以双下肢及臀部为主,呈对称分布。可伴有关节肿痛、腹痛、呕吐、便血,肾脏受累时可出现血尿和蛋白尿。较少的病例还可累及循环系统发生心肌炎和心包炎；累及呼吸系统发生喉头水肿、哮喘、肺出血；偶可出现睾丸炎及中枢神经系统血管炎等。发病年龄多为学龄期儿童。本病虽有反复发作倾向,但如无肾脏受累,大多数预后良好,故肾脏受累及其严重程度是决定过敏性紫癜患儿预后最为关键的因素。因此寻找过敏性紫癜肾脏受累的高危因素,以便尽早采取干预措施,预防或减轻肾脏损害的发生和发展,对改善预后有极其重要的意义。目的探讨过敏性紫癜患儿并发肾脏损害的高危因素。方法全面检索相关期刊论文、万方期刊及学位论文全文数据库、中文科技期刊数据库、中国生物医学文献数据库,PubMed、CALIS外文期刊网、并辅以文献追溯、手工检索等方法收集2000年1月至2011年10月公开发表的关于过敏性紫癜并发肾脏损害高危因素的临床资料。纳入原始研究、评价质量、提取资料并进行核对,剔除不符合本研究标准的研究文献,最后对所纳入的研究数据采用Cochrane协作网提供的Review Manger软件(Revman4.2)进行统计分析。根据文献异质性检验结果,进行固定效应模型或随机效应模型的Meta分析。计算各指标的比值比(Odds Ratio, OR)及其95%的可信区间(Confidence Interval, CI)。结果共有13项研究包括4322例患者符合纳入标准,其中合并肾脏损害的患儿累计1481例。各研究均为回顾性研究。提取资料行统计分析结果示,合并肾脏损害组与无肾脏损害组：1.年龄=10岁。其合并OR值为3.18,95%CI=[1.86-5.43],总体的效应检验,Z=4.24,p0.00001,结果有统计学意义。2.性别为男性。其合并OR值为1.22,95%CI=[0.93-1.60],总体的效应检验,Z=1.45,p=0.15,结果无统计学意义。3.腹痛。其合并OR值为2.07,95%CI=[1.40-3.07],总体的效应检验,Z=3.64,p=0.0003,结果有统计学意义。4.关节肿痛。其合并OR=1.17,95%CI=[0.94-1.45],总体效应检验,Z=1.44,p=0.15,结果无统计学意义。5.消化道出血。合并OR=2.10,95%CI=[1.61-2.74],总体效应检验,Z=5.44,p0.00001,结果有统计学意义。6.紫癜反复。其合并OR=3.64,95%CI=[2.66-4.98],总体效应检验,Z=8.07,p0.00001,结果有统计学意义。7.WBC10×109/L,其合并OR=1.05,95%CI=[0.83-1.31],总体效应检验,Z=0.39,p=0.70,结果无统计学意义。8.PLT300×109/L。其合并OR=1.07,95%CI=[0.84-1.38],总体效应检验,Z=0.55,p=0.59,结果无统计学意义。结论1.通过以上8项研究发现过敏性紫癜并发肾脏损害的高危因素为：年龄=10岁、腹痛、消化道出血、紫癜反复。 2.以OR为效应指标,按照Wynder标准,腹痛、消化道出血与过敏性紫癜并发肾脏损害呈中度关联；年龄=10岁、紫癜反复与过敏性紫癜并发肾脏损害呈强关联。 3.由于纳入文献均为回顾性研究,且设计方面不够严谨,故存在发生各种偏倚的可能性。进一步结论的得出有待于多个设计科学的、多中心的、大样本的前瞻性研究证实。
[Abstract]:Background anaphylactoid purpura (anaphylactoid purpura), also known as Henoch-Schonlein syndrome (Henoch-Schonlein purpura, HSP), is the most common systemic vasculitis with small vasculitis as the main disease in childhood. The clinical features are mainly blood small plate not reducing sexual purpura, with both lower limbs and buttocks. It can be accompanied by joint swelling and pain, abdominal pain, vomiting, hematuria, hematuria and proteinuria when the kidney is involved. Fewer cases may also involve circulatory myocarditis and pericarditis; laryngedema, asthma, and pulmonary hemorrhage are involved in the respiratory system, and even the occurrence of testosterone and central nervous system vasculitis. For school-age children, although the disease has recurrent seizures, but if there is no kidney involvement, most of the prognosis is good, so renal involvement and its severity is the most critical factor in determining the prognosis of children with anaphylactoid purpura. Therefore, to find the high-risk factors of the renal involvement of anaphylactoid purpura so as to take early intervention measures to prevent or alleviate renal damage. The occurrence and development of this disease is of great importance for improving prognosis.
Objective to investigate the risk factors of renal damage in children with Henoch Schonlein purpura.
Methods the full-text database of Chinese periodicals, the full text database of the Wanfang periodicals and the dissertations, the database of Chinese sci-tech periodicals, the Chinese biomedical literature database, the PubMed, the CALIS foreign periodicals network, and the methods of literature retroactive and manual retrieval were collected and published in January 2000 to October 2011 on Henoch Schonlein purpura complicated with kidney. The clinical data of the high risk factors of dirty damage were included in the original study, evaluation of quality, extraction of data and checking, eliminating research documents that did not conform to the standards of this study. Finally, the included research data were analyzed by the Review Manger software (Revman4.2) provided by the Cochrane collaboration network. Meta analysis of fixed effect model or random effect model. Odds Ratio (OR) and its 95% confidence interval (Confidence Interval, CI) were calculated.
Results a total of 13 studies included 4322 patients in conformity with the inclusion criteria, of which 1481 cases were combined with renal damage. All the studies were reviewed. The results of the study were reviewed. The results of the statistical analysis showed that the renal damage group and the non renal damage group were at the age of 1. =10 years. The combined OR value was 3.18,95%CI=[1.86-5.43], the overall effect test, Z =4.24, p0.00001, the results were statistically significant,.2. sex was male. The combined OR value was 1.22,95%CI=[0.93-1.60], the overall effect test, Z=1.45, p=0.15, the results were not statistically significant.3. abdominal pain. The combined OR value was 2.07,95%CI=[1.40-3.07], the overall effect test, Z=3.64, p=0.0003, the results were statistically significant. .17,95%CI=[0.94-1.45], total effect test, Z=1.44, p=0.15, no statistically significant.5. gastrointestinal bleeding. Combined with OR=2.10,95%CI=[1.61-2.74], total effect test, Z=5.44, p0.00001, the results were statistically significant.6. purpura repeated. It combined OR=3.64,95%CI=[2.66-4.98], general effect test, Z=8.07, p0.00001, the results were statistically significant. .7.WBC10 x 109/L, with the combination of OR=1.05,95%CI=[0.83-1.31], total effect test, Z=0.39, p=0.70, the results were not statistically significant.8.PLT300 x 109/L. with OR=1.07,95%CI=[0.84-1.38], total effect test, Z=0.55, p=0.59, the results were not statistically significant.
Conclusion 1. through the above 8 studies, the risk factors for renal damage in Henoch Schonlein purpura were found to be =10 years old, abdominal pain, gastrointestinal bleeding, and purpura relapse.
2. with OR as the effect index, according to the Wynder standard, abdominal pain, gastrointestinal bleeding and Henoch Schonlein purpura have moderate renal damage. Age =10 years, Henoch Schonlein purpura and Henoch Schonlein purpura complicated renal damage is strongly associated.
3. as the literature is reviewed, and the design is not rigorous enough, there is a possibility of a variety of bias. Further conclusions need to be confirmed by a number of design science, multicenter, large sample prospective studies.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.5

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