同型半胱氨酸与儿童动脉缺血性卒中发病风险的Meta分析

发布时间：2018-11-08 21:02

【摘要】：目的:探讨同型半胱氨酸(homocysteine,Hcy)与儿童动脉缺血性卒中(Pediatric arterial ischemic stroke,PAIS)发病风险的相关性。方法:检索1995年1月至2017年2月CNKI、万方、维普、EMBASE、Pubmed、Cochrane等数据库,收集Hcy与PAIS的相关文献,按Cochrane系统评价方法评估纳入文献的质量。选取PAIS与对照组高血清Hcy的比值比(odds ratio,OR)和血清Hcy水平差异为效应指标,提取纳入研究的结果,运用stata软件对纳入研究结果进行异质性检验,合并分析高血清Hcy的OR及血清Hcy水平的差异,并用单因素Meta回归分析探索异质性来源。结果:按照文献纳入和排除标准,经筛选后纳入Meta分析的文献共7篇。1.以高血清Hcy的OR作为显效分析统计量纳入5篇文献,Meta分析结果:共有694患者纳入本次分析,其中PAIS组192例,健康儿童组502例,经异质性检验,chi-squared=8.55,自由度为4,I2=53.2%(P=0.073),采用固定效应模型进行分析,合并OR为4.473(CI:2.13,9.38);总体效应检验Z=3.96(P0.01),有统计学意义。2.以血清Hcy水平作为显效分析统计量纳入4篇文献,Meta分析结果:共有4389患者纳入本次分析,其中PAIS组159例,健康儿童组4230例,经异质性检验,chi-squared=8.56,自由度为3,I2=65.0%(P=0.036),异质性较大,故采用随机效应模型进行分析,合并后标准化均差(standardised mean difference,SMD)为0.097(CI:-0.223,0.416);总体效应检验Z=0.059(P=0.552),无统计学意义。结论:1.高血清Hcy血症在PAIS人群中所占比例较健康儿童高,提示高血清Hcy血症可能增加PAIS的发病风险。2.关于PAIS血清Hcy水平是否异常的研究报道存在争议,Meta分析提示目前尚无充足的临床证据表明PAIS血清Hcy平均水平显著高于健康儿童。
[Abstract]:Objective: to investigate the relationship between homocysteine (homocysteine,Hcy) and risk of ischemic stroke (Pediatric arterial ischemic stroke,PAIS) in children. Methods: from January 1995 to February 2017, the databases of CNKI, Wanfang, Weip and EMBASE,Pubmed,Cochrane were searched, and the related documents of Hcy and PAIS were collected, and the quality of the literature was evaluated according to the evaluation method of Cochrane system. The ratio (odds ratio,OR) of high serum Hcy and the difference of serum Hcy level between PAIS and control group were selected as effect indexes. The results of the study were extracted, and the heterogeneity of the results was tested by stata software. The differences of OR and Hcy levels in high serum Hcy were analyzed and the heterogeneity sources were explored by univariate Meta regression analysis. Results: according to the criteria of literature inclusion and exclusion, 7 articles were selected for Meta analysis. 1. The results of Meta analysis were as follows: there were 192 cases in PAIS group and 502 cases in healthy children group. The degree of freedom of chi-squared=8.55, was 4 by heterogeneity test. I _ (2) was 53.2% (P _ (0.073). The fixed effect model was used to analyze it, and the combined OR was 4.473 (CI:2.13,9.38). The total effect test was 3.96 (P0.01), which had statistical significance. The results of Meta analysis showed that 4389 patients were included in the study, including 159 cases in PAIS group and 4230 cases in healthy children group. The degree of freedom of chi-squared=8.56, was 3% by heterogeneity test. The heterogeneity of I2P was 65.0% (P0. 036), so the standardized mean difference (standardised mean difference,SMD) was 0.097 (CI:-0.223,0.416) by using random effect model. The total effect test was 0.059 (P0. 552), and there was no statistical significance. Conclusion: 1. The proportion of high serum Hcy in PAIS was higher than that in healthy children, suggesting that high serum Hcy may increase the risk of PAIS. 2. There is controversy about whether the serum Hcy level of PAIS is abnormal. Meta analysis shows that there is not enough clinical evidence to show that the average level of PAIS serum Hcy is significantly higher than that of healthy children.
【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】：R743.3

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