中国儿童感染性心内膜炎的meta分析

发布时间：2019-01-16 07:53

【摘要】：目的:运用R软件进行meta分析,综合评价中国儿童感染性心内膜炎(infective endocarditis,IE)的临床特点、并发症、实验室检查、赘生物位置、治疗及结局。方法:检索万方数据库、维普信息资源系统、中国知网期刊全文数据库以及Pub Med数据库,收集2016年3月之前所有关于儿童感染性心内膜炎的文献,再从中筛选出符合纳入标准的单中心横断面研究。使用R软件对儿童IE的临床特点、并发症、实验室检查、赘生物位置、治疗及结局各事件进行率的综合分析,合并前先行进行异质性检验,根据结果以确定采用固定模型或随机模型进行率的合并,然后运用Egger检验进行发表偏倚的评估,利用meta回归和亚组分析评估异质性来源。结果:本研究共纳入相关文献16篇,病例数892例,男童的合并率为55%(95%CI:51%-58%)。IE绝大多数具有潜在基础心脏疾病,先天性心脏病(CHD)的合并率为68%(95%CI:62%-72%),其中室间隔缺损(VSD)为33%(95%CI:27%-40%);风湿性心脏病(RHD)的合并率为10%(95%CI:7%-14%)。最常见的临床表现为发热,合并率为89%(95%CI:84%-93%),其他包括脾肿大、杂音改变及皮肤瘀斑、瘀点等。并发症中栓塞的合并率为22%(95%CI:19%-26%),心力衰竭的合并率为45%(95%CI:34%-56%)。病原学检查中,革兰氏阳性菌(G+菌)的合并率为87%(95%CI:83%-90%),其中最常见的是金黄色葡萄球菌,其次为草绿色链球菌;革兰氏阴性菌(G-菌)为9%(95%CI:7%-13%),真菌为5%(95%CI:3%-8%),HACEK菌罕见。赘生物检出阳性的合并率为78%(95%CI:67%-86%),累积左心与右心的合并率分别为60%(95%CI:43%-75%)和33%(95%CI:21%-48%)。手术治疗的合并率为21%(95%CI:13%-32%),合并死亡率为14%(95%CI:10%-18%)。各地区的死亡率有差异,国内华中的合并死亡率高于华南。结论:小儿IE是罕见且具有死亡威胁的疾病。我国儿童IE的死亡率高,并且具有地区差异,积极预防对降低死亡率有帮助。IE最常见的潜在心脏疾病是CHD,但RHD仍为重要危险因素;最主要的致病菌为金黄色葡萄球菌,赘生物最常累积的部位为左心。IE的临床表现越来越不典型,早期诊断依赖于血培养及超声检查。
[Abstract]:Objective: to evaluate the clinical features, complications, laboratory findings, vegetative location, treatment and outcome of infective endocarditis (infective endocarditis,IE) in Chinese children by using R software for meta analysis. Methods: to search Wanfang database, Weipu information resource system, full text database of Chinese journal and Pub Med database, and collect all the literatures about infective endocarditis in children before March 2016. A single center cross-sectional study which meets the inclusion criteria was selected from the study. R software was used to analyze the clinical characteristics, complications, laboratory examination, vegetative location, treatment and outcome of IE in children. The results were used to determine the combination of rates using a fixed model or a random model, and then Egger test was used to evaluate publication bias, and meta regression and subgroup analysis were used to evaluate the heterogeneity source. Results: a total of 16 related literatures were included in this study, 892 cases were included in the study. The rate of boys' merger was 55% (95% CI: 51% -58%) with underlying heart disease, most of them had underlying heart disease. The combined rate of congenital heart disease (CHD) was 68% (95 CI: 62-72%), and (VSD) of ventricular septal defect (VSD) was 33% (95 CI: 27- 40%). The combined rate of rheumatic heart disease (RHD) was 10% (95% CI: 7-14%). The most common clinical manifestation was fever, with a combined rate of 89% (95 CI: 84-93%), including splenomegaly, murmur and skin ecchymosis, stasis points, etc. The combined rate of embolism was 22% (95 CI: 19-26%) and heart failure was 45% (95 CI: 34-56%). The combined rate of Gram-positive bacteria (G) was 87% (95 CI: 83-90%), among which Staphylococcus aureus was the most common, followed by Streptococcus grass green. Gram-negative bacteria (G- bacteria) were 9% (95% CI: 7- 13%), fungi were 5% (95% CI: 3 -8%), HACEK). The positive rate was 78% (95 CI: 67-86%), the combined rate of accumulated left heart and right heart was 60% (95 CI: 43 -75%) and 33% (95 CI: 21 -48%). The combined rate of surgical treatment was 21% (95% CI: 13-32%) and the combined mortality rate was 14% (95 CI: 10% -18%). The mortality rate of central China is higher than that of South China. Conclusion: IE is a rare and death threatening disease in children. The mortality rate of IE in children in China is high and there are regional differences. Active prevention is helpful to reduce mortality. CHD, is the most common latent heart disease in IE but RHD is still an important risk factor. Staphylococcus aureus is the main pathogenic bacteria and the most common accumulation of vegetations is left heart. The clinical manifestations of IE are becoming more and more atypical. Early diagnosis depends on blood culture and ultrasound examination.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R725.4

【参考文献】