sICAM-1与银屑病相关性的Meta分析

发布时间：2018-03-30 14:52

本文选题：银屑病　切入点：系统评价　出处：《河北医科大学》2010年硕士论文

【摘要】： 目的:银屑病是皮肤科一种常见的慢性炎症性增殖性疾病。其病程长,难治愈,易复发给患者生活质量造成很大负面影响。银屑病的病因至今不明。目前研究大多数认为银屑病发病与T细胞介导的免疫有关。银屑病发病的免疫机理主要概括为外源性诱导性抗原和内源性自身抗原被朗格汉斯细胞、树突状细胞等抗原递呈细胞捕获后表达于细胞表面。成熟的抗原递呈细胞经血管进入皮肤淋巴结,将抗原递呈给自然T细胞。自然T细胞经活化、分化、增殖成为致病的记忆效应性T细胞。记忆效应性T细胞迁移到皮肤并在病灶区诱导产生各种炎症因子和细胞因子,导致了银屑病一系列病理改变。目前较公认的是皮损内异常浸润的T淋巴细胞及细胞因子的作用是银屑病发病的关键步骤。sICAM-1(可溶性细胞间粘附分子1)就是重要的细胞因子之一。近年定量测定银屑病患者sICAM-1的研究较多,研究样本量大小不一,结果不尽一致。Meta分析是对已有的资料进行综合分析和评价的方法,它可以对具有相同研究目的多个独立研究结果进行综合统计分析和评价。Meta分析能够改进和提高由于样本量小而影响的统计效能;可以对某些研究结果不一致的情况作出较客观的判断,得出较为可靠的结论;解释了在单独研究中尚未解释或不能解释的问题。本研究通过Meta分析的方法评价sICAM-1与银屑病相关性。为银屑病病因相关研究及治疗提供客观的参考依据。方法:以检索词:Psoriasis、Soluble intercellular adhesion molecule-1、sICAM-1、银屑病、可溶性细胞间粘附分子1,检索数据库:Cochrane图书馆、PubMed、中国学术文献网络出版总库(含硕博论文)(CNKI新)、中国生物文献服务系统(sinomed)。纳入所有研究sICAM-1与银屑病相关性的配对与非配对的病例对照研究。由2名评价者共同评价纳入研究质量。采用RevMan4.2.8软件对纳入文献进行Meta分析。结果:共纳入21篇配对或非配对的病例对照研究,包括银屑病患者788例,正常对照624例。所有研究均采用ELISA方法检测银屑病患者及?正常对照志愿者外周血血清中sICAM-1的浓度。部分研究说明了所用检测方法的灵敏度、特异度及重复性。通过分析发现未分型,分期银屑病患者高于正常对照Z = 4.70 (P 0.00001)、WMD147.68、95%CI(86.05, 209.31);寻常型银屑病患者高于正常对照Z = 6.14 (P 0.00001)、WMD152.95、95%CI(104.09, 201.81);进行期银屑病患者高于正常对照Z = 4.85 (P 0.00001)、WMD176.04、95%CI(104.94, 247.14);静止期银屑病患者高于正常对照Z = 3.14 (P = 0.002)、WMD89.69、95%CI(33.64, 145.74);退行期银屑病患者与正常对照无差别Z = 1.44 (P = 0.15)、WMD81.49、95%CI(-29.75, 192.73);进行期银屑病患者高于静止期银屑病患者Z = 4.25 (P 0.0001)、WMD83.06、95%CI(44.76, 121.37);进行期银屑病患者高于退行期银屑病患者Z = 10.84 (P 0.00001)、WMD125.12、95%CI(102.50, 147.74);静止期银屑病患者与退行期银屑病患者无差别Z = 1.09 (P = 0.28)、WMD36.69、95%CI(-29.39, 102.76)。银屑病患者血清sICAM-1浓度与患者PASI评分呈正相关关系。结论:研究结果显示,未分型分期银屑病患者及寻常型银屑病患者血清中sICAM-1水平升高,表明银屑病的发病与sICAM-1升高相关。进行期、静止期银屑病患者血清中sICAM-1水平高于正常对照,说明银屑病进行期和静止期血清中sICAM-1与病情的严重程度有关。呈正相关性。退行期银屑病患者血清中sICAM-1水平与正常对照无差别,说明随着银屑病病情好转,进入退行期血清中sICAM-1水平也下降到近似正常水平更加说明血清中sICAM-1水平与病情的活动有关。进行期银屑病患者血清中sICAM-1水平高于静止期及退行期银屑病患者,说明病情由发展到维持或消退血清中sICAM-1水平均有明显下降。此现象也说明血清中sICAM-1水平与病情的的严重程度有关。静止期银屑病患者与退行期银屑病患者血清中sICAM-1水平无差别说明病情由维持到消退阶段血清中sICAM-1水平下降已不明显。银屑病患者血清sICAM-1浓度与皮损PASI评分有统计学意义且呈正相关。本文研究结果显示血清sICAM-1水平与银屑病的临床分期及严重程度有关。由于本研究及纳入文献存在一定局限性,期待将来高质量的文献纳入本研究,进一步验证本研究结果。
[Abstract]:Objective: Department of Dermatology psoriasis is a common chronic inflammatory proliferative disease. Its long course, difficult to cure, easy relapse to the quality of life of patients caused great negative impact. The cause of this disease is still unknown. At present most studies that the pathogenesis of psoriasis and T cell mediated immunity. The main mechanism of the immune pathogenesis of psoriasis is summarized exogenous and endogenous antigen induced self antigen is langer Hans cells, dendritic cells and antigen presenting cells expressed on the cell surface. After the capture of mature antigen-presenting cells through blood vessels into the skin lymph node, present antigen to T cells. The natural natural T cell activation, differentiation, proliferation become pathogenic memory effect T cells. Memory effect of T cells to migrate to the skin and induce lesions in various inflammatory factors and cytokines, cause a series of pathological changes of psoriasis. The Is recognized as T lymphocytes and cytokines in lesions with abnormal infiltration of the role of.SICAM-1 is the key step in the pathogenesis of psoriasis (soluble intercellular adhesion molecule 1) is one of the most important cytokines. More research in the quantitative determination of sICAM-1 in patients with psoriasis, the amount of sample size, the results are not consistent with.Meta analysis method make a comprehensive analysis and evaluation on the existing data, it can have the same purpose of multiple independent research results of comprehensive statistical analysis and evaluation.Meta analysis can improve and improve due to the small sample size affects the efficiency of the statistics; on some research results inconsistent situation objectively judge, draw more reliable conclusion; explain the explanation in the separate studies have not yet been or can not explain the problem.
This study evaluated the correlation between sICAM-1 and psoriasis by Meta analysis, and provided an objective reference for the related research and treatment of psoriasis.
Methods: the key words: Psoriasis Soluble, intercellular adhesion molecule-1, sICAM-1, psoriasis, soluble intercellular adhesion molecule 1, database: Cochrane library, PubMed, China Academic Literature Network Publishing Database (including thesis) (CNKI), China biological literature service system (sinomed). In the control study of all related research sICAM-1 and psoriasis paired with non paired cases. By 2 reviewers evaluated the quality of studies. Meta analysis of the literature by RevMan4.2.8 software.
Results: a total of 21 paired or non paired case-control study, including 788 cases of patients with psoriasis, 624 cases of normal control. All studies were detected by ELISA in patients with psoriasis and normal control? SICAM-1 concentration in serum of volunteers. Some studies illustrate the sensitivity of detection methods for the specificity and repetition through the analysis found. Without typing, staging in patients with psoriasis is higher than the normal control Z = 4.70 (P 0.00001), WMD147.68,95%CI (86.05, 209.31); the patients with psoriasis vulgaris is higher than the normal control Z = 6.14 (P 0.00001), WMD152.95,95%CI (104.09, 201.81); of psoriasis patients than normal control (Z = 4.85 P 0.00001), WMD176.04,95%CI (104.94, 247.14); patients with psoriasis still higher than the normal control Z = 3.14 (P = 0.002), WMD89.69,95%CI (33.64, 145.74); catagen psoriasis patients and normal controls, no difference in Z = 1.44 (P = 0.15), WMD81.49,95%CI (-29.75, 192.73); of psoriasis patients were higher than the resting stage in patients with psoriasis Z = 4.25 (P 0.0001), WMD83.06,95%CI (44.76, 121.37); of psoriasis patients than in patients with psoriasis catagen Z = 10.84 (P 0.00001), WMD125.12,95%CI (102.50, 147.74); stationary psoriasis patients with psoriasis catagen no difference Z = 1.09 (P = 0.28), WMD36.69,95%CI (-29.39, 102.76). The serum concentration of sICAM-1 in patients with psoriasis and PASI score were positively correlated.
Conclusion: the results showed that no type of elevated stage sera of patients with psoriasis patients with psoriasis vulgaris and sICAM-1, suggesting that sICAM-1 and increased incidence of psoriasis. The period, the level of serum sICAM-1 in patients with psoriasis vulgaris in stationary phase was higher than the control, indicating the severity of illness and 5-LO sICAM-1 in serum and resting periods the positive correlation. The level of serum sICAM-1 in patients with psoriasis catagen and normal control had no difference with psoriasis condition improved, serum levels of sICAM-1 into catagen also decreased to near normal levels more shows in serum sICAM-1 levels and disease activity. SICAM-1 serum levels in patients with psoriasis is higher than that of patients in resting and degeneration psoriasis, explain the illness from growth to maintain or subside in serum sICAM-1 levels were significantly decreased. This phenomenon also said The serum sICAM-1 levels and disease severity. The level of sICAM-1 in patients with psoriasis and catagen telogen psoriasis in patients with no difference to explain the illness by maintaining the level of sICAM-1 in serum decreased subsided stage was not obvious. The serum concentration of sICAM-1 in patients with psoriasis lesions and PASI scores were statistically significant and positive correlation.
The results of this study show that serum sICAM-1 level is related to the clinical stages and severity of psoriasis. Due to the limitations of this study and the inclusion of literature, we expect high quality literature to be included in this study, and further verify the results of this study.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R758.63

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