C反应蛋白与脑出血预后的系统评价

发布时间：2018-03-24 20:25

  本文选题：C反应蛋白　切入点：脑出血　出处：《河南科技大学》2017年硕士论文

【摘要】：目的:脑出血(Intracerebral Hemorrhage,ICH),是指原发性非外伤性脑实质内出血,又称自发性脑出血,在我国占卒中的17.1%-55.4%,年发病率为60-80/10万人,急性期病死率为30%-40%,病死率居于急性脑血管病首位。关于脑出血的治疗和预后评估的研究一直滞后于缺血性脑卒中,而且一直缺乏循证医学证实的有效治疗手段。既往公认入院时格拉斯哥昏迷评分、脑出血量、出血部位、年龄等因素与患者的预后密切相关,所以只是采用手术或药物针对颅内高压和脑水肿对症治疗,现在越来越多的研究表明,脑出血后引起的脑组织周围炎症反应,是加重脑损伤的重要途径。C反应蛋白(C-reactive protein,CRP)是炎症、感染、损伤等刺激下主要由肝脏产生的一种急性反应蛋白,脑出血时一系列复杂的损伤机制中均伴发着炎症反应,许多研究都证实脑出血患者体内C反应蛋白水平会有不同程度的改变,且患者预后相关。本研究旨在统评价C反应蛋白对脑出血患者预后的影响,通过循证医学的角度,更加科学的评估C反应蛋白与脑出血患者预后的相关性,为进一步临床研究及应用提供可靠证据。方法:采用Cochrane系统评价方法,计算机检索Pub Med、The Cochrane Library、EMbase、相关期刊论文(CNKI)、万方数据库(Wan Fang Data)、中文科技期刊全文数据库(VIP),同时手工检索相关资料及各研究参考文献目录,查找所有关于C反应蛋白与脑出血预后影响的研究,检索时限均为从建库至2016年9月。经全面搜索资料库后,由2位评价员按照纳入与排除标准独立进行筛选文献,如遇分歧,则讨论解决或交由第三方协助裁定。最后按预先设计的资料提取表格提取资料、评价纳入研究的方法学质量。应用纽卡斯尔一渥太华量表评价队列研究,评分5~9颗星为高质量研究。提取全部研究所需资料和评价纳入研究的方法学质量后,采用RevMan 5.3软件进行Meta分析。结果:共纳入13个观察性研究(英文文献6篇、中文文献7篇),共2298例患者。Meta分析结果显示:(1)与正常人群相比,脑出血患者入院时血清CRP水平较正常人群明显升高,其差异有统计学意义[MD=6.26,95%CI(5.91,6.62),P0.00001]。(2)脑出血患者中1周内死亡的患者入院时血清CRP水平明显高于存活组,其差异有统计学意义[MD=3.00,95%CI(1.04,4.96),P=0.003];脑出血患者中1月内死亡的患者入院时血清CRP水平明显高于存活组,其差异有统计学意义[MD=2.27,95%CI(1.67,2.87),P0.00001];脑出血患者中半年内死亡的患者入院时血清CRP水平明显高于存活组,其差异有统计学意义[MD=2.62,95%CI(0.97,4.28),P=0.002];脑出血患者中1年内死亡的患者入院时血清CRP水平明显高于存活组,其差异有统计学意义[MD=2.09,95%CI(0.92,3.26),P=0.0005]。将所有亚组汇总分析后,结果亦显示死亡组患者入院时血清CRP水平明显高于存活组[MD=2.31,95%CI(1.82,2.80),P0.00001],说明入院时血清CRP水平越高,患者的短期死亡风险越高,所有对比均有统计学意义。(3)预后较差的脑出血患者入院时血清CRP水平明显高于预后良好的患者,其差异有统计学意义[MD=2.86,95%CI(1.38,4.34),P=0.0001]。入院时CRP水平升高的脑出血患者发生预后不良的风险比CRP水平正常的脑出血患者高8.12倍,两组比较有统计学意义[OR=8.12,95%CI(4.72,13.96),P0.00001]。结论:现有证据显示,脑出血患者急性期血清CRP水平较正常人群明显升高,且与脑出血患者预后有关。但受纳入研究的数量与质量的限制,上述结论有待更多大样本、多中心、高质量的研究加以验证。
[Abstract]:Objective: cerebral hemorrhage (Intracerebral, Hemorrhage, ICH), refers to the primary non traumatic intracerebral hemorrhage, also known as spontaneous cerebral hemorrhage, stroke in China accounted for 17.1%-55.4%, the annual incidence rate of 60-80/10 million people, the death rate in acute stage of 30%-40%, the mortality rate in acute cerebrovascular disease research and treatment first. Assessment of cerebral hemorrhage and prognosis of ischemic stroke has been lagging behind, and has been the lack of effective treatment on medicine confirmed. Previously recognized admission Glasgow coma score, cerebral hemorrhage, bleeding site, prognostic factors such as age and patients are closely related, so only by surgery or drugs for intracranial hypertension and cerebral edema symptomatic treatment, now more and more studies show that peripheral inflammation induced by cerebral hemorrhage in brain tissue, is an important way to aggravate brain injury.C reactive protein (C-reactive protein, CRP) is inflammation, An acute infection, C-reactive protein damage and other stimuli produced mainly by the liver, cerebral hemorrhage is a complex series of damage mechanisms were associated with inflammatory reaction, many studies have confirmed that the level of serum C reactive protein in patients have different degrees of change of cerebral hemorrhage and the prognosis of patients. The purpose of this study is to influence the system evaluation of C reactive protein on the prognosis of patients with cerebral hemorrhage, through the perspective of evidence-based medicine, the prognosis of patients with more scientific assessment of the correlation between C reactive protein and cerebral hemorrhage, for further clinical research and application provide reliable evidence. Methods: the Cochrane, Med The Cochrane searched Pub, Library, EMbase, China journal full text database (CNKI), Wanfang database (Wan Fang Data), Chinese PSTP (VIP), and hand searching related information and the research reference list, find the relevant Study on C reactive protein and prognosis of cerebral hemorrhage, were searched from inception to September 2016. After a comprehensive search database, by 2 reviewers independently according to the inclusion and exclusion criteria were screened in case of disagreement, then discuss solutions or by the third parties to assist decision. Finally, according to the pre designed data extraction table data extraction, quality evaluation methods included in the study. The application of Newcastle Ottawa scale evaluation cohort study, scores of 5~9 stars for high quality research. The quality of all the required information extraction and evaluation methods included in the study, Meta analysis was performed using RevMan 5.3 software. Results: 13 observational studies were included (English 6 articles, Chinese 7 articles), a total of 2298 cases of patients with.Meta analysis results showed that: (1) compared with the normal population, patients with cerebral hemorrhage serum level of CRP was significantly higher than the normal population, the 宸�寮傛湁缁熻�″�︽剰涔塠MD=6.26,95%CI(5.91,6.62),P0.00001].(2)鑴戝嚭琛，

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