D-二聚体与糖尿病视网膜病变相关性的Meta分析

发布时间：2018-04-14 16:34

本文选题：糖尿病视网膜病变 + D-二聚体　；参考：《广州医科大学》2017年硕士论文

【摘要】：目的通过对国内外2型糖尿病患者中DR与NDR患者血浆D-二聚体水平,以及糖网病变程度与其相关性的观察性研究进行Meta分析,探讨D-二聚体与糖尿病视网膜病变的相关性,为临床诊治提供依据。资料和方法计算机检索Pubmed、Cochrane Library、PMC、万方数据库、维普等全文数据库,中文检索词为“糖尿病视网膜病变”、“D-二聚体”、“二聚体”,英文检索词为“diabetic retinopathy”、“diabetes retina”、“d-dimer”和“D-D”,检索时间至2017年3月。共检索得出相关文献156篇,其中包括Pubmed 12篇,万方数据库42篇,PMC 83篇,维普数据库19篇,Cochrane Library 0篇。依据提前设定的纳入及排除标准,使用Note Express软件进行文献筛选,对全部潜在文献进行全文检索,其中3篇文献未检索到全文,予以排除,剩余文献31篇。阅读全文文献后排除无明确诊断分组文献1篇,文献记录数据与原文结论不符文献1篇,存在研究数据重复发表可能文献1篇,缺少NDR对照组文献1篇,缺少可提取数据1篇,缺少明确分组指标文献1篇,未排除全身重大疾病如心脑血管、肝肾、肿瘤、妊娠、代谢、急慢性炎症或影响凝血、纤溶系统药物服用史文献19篇。剩余初步纳入文献共计6篇.对纳入文献进行证据评级、质量评价和数据提取。6篇研究提取病例组、对照组的样本量,D-二聚体测量水平均数及标准差作为合并统计量,病例组(DR组)合并样本量为391例,对照组(NDR组)合并样本量为353例,4篇进行DR组亚组分型的研究中,中NPDR组合并样本量为182例,PDR组合并样本量为114例。各研究间度量衡单位不一致,采用标准化均数差(SMD)表示结果。结果如下:(1)经异质性检验,DR组与NDR组合并效应量对比后的I2=96%,p=0.03,敏感性分析显示逐一去除各项研究后异质性I2均大于50%,敏感性分析不明显,提示纳入研究异质性较大,组间差异有统计学意义,采用随机效应模型进行合并分析;(2)NPDR组与NDR组合并效应量对比后的I2=92%,p=0.07,行敏感性分析后I250%,异质性较大,采用随机效应模型合并数据量;(3)PDR组与NDR组合并效应量对比后I2=97%,p=0.02,敏感性分析后I250%,异质性较大,采用随机效应模型合并数据量;(4)PDR组与NPDR组合并效应量对比后各组合并效应量对比后I2=87%,p=0.01,敏感性分析后I250%,异质性较大,采用随机效应模型合并数据量。结果根据纳入研究类型使用NOS评价标准进行文献质量评价,纳入文献质量评价为中等。合并效应量结果显示,在DR组和NDR组总体数据对比中,DR组患者D-二聚体平均水平为NDR组患者的0.99倍,95%置信区间(CI)[0.12,1.85]。亚组分析中,NPDR组D-二聚体平均水平为NDR组0.67倍,95%CI[-0.06,1.39];PDR组D-二聚体水平为NDR组1.82倍,95%CI[0.24,3.40]。PDR组与NPDR组间对比中,PDR组D-二聚体平均水平为NDR组0.96倍,95%CI[0.22,1.69]。NPDR组与NDR组对比95%CI无统计学意义,其余各组合并效应量及95%CI均有统计学意义。总合并效应量及亚组合并效应量提示在DR患者中D-二聚体水平较NDR患者提高,特别在PDR患者中提高更显著。STATA 12.0软件生成DR组与NDR组漏斗图,漏斗图示不对称。Begg及Egger检验结果,p=0.3260.05,提示研究间发表偏倚存在可能性低,Meta分析结果较可信。结论1.在PDR患者中D-二聚体水平较NDR及NPDR患者提高。2.监测NDR及NPDR血浆D-二聚体水平变化,有助于提高对PDR患者的筛出率及诊治率,同时利于监测病程发展。3.DR患者中D-二聚体升高可能与DR患者机体内凝血纤溶系统异常和炎症反应有关。
[Abstract]:By DR and D- in plasma of patients with NDR at home and abroad in patients with type 2 diabetes and two level of D-dimer, and observational studies associated with the degree of sugar network lesions were analyzed by Meta, to investigate the correlation between D- two dimer and diabetic retinopathy, provide the basis for clinical diagnosis and treatment. Materials and methods of computer retrieval Pubmed, Cochrane Library, PMC, Wanfang database, VIP database, Chinese the key words of "diabetic retinopathy," D- two "dimer", "two dimers, English the key words of" diabetic retinopathy "," diabetes retina "," D-dimer "and" D-D ", the retrieval time to March 2017. Obtains the total 156 related articles, including Pubmed 12, Wanfang database 42, PMC 83, VIP database 19, Cochrane Library 0. According to the inclusion and exclusion criteria set in advance, the use of Note Express software For the screening of all the potential for full-text retrieval literature, including 3 articles were retrieved, excluded, the remaining 31 literatures. Read the literature after the exclusion of no clear diagnosis group 1 literature, literature data and record the original conclusion is inconsistent with 1 references of research data duplication may be 1 references the lack of NDR control group of 1 references, the lack of data can be extracted 1 articles, the lack of clear indicators of 1 articles, not to exclude systemic major diseases such as cardiovascular, kidney, cancer, pregnancy, metabolism, acute and chronic inflammation or affect blood coagulation, fibrinolysis system history of medicine taking 19 papers. The remaining initially included 6 articles altogether. Evidence rating of the literature, assessment and data extraction.6 study sample extraction quality of case group and control group, two D- dimer level measurement of mean and standard deviation as the combined statistics, case group (DR group) with sample size In 391 cases, the control group (group NDR) samples with 353 cases, 4 were DR group subgroup study, the combination of NPDR and sample of 182 cases, combination of PDR and sample of 114 cases. Between the various research units of measurement is not consistent with the standardized mean difference (SMD) said the results. The results are as follows: (1) after heterogeneity test, I2=96%, DR group and NDR combined effect is compared after p=0.03, sensitivity analysis showed that the removal of the heterogeneity of the study by I2 was greater than 50%, the sensitivity analysis is not obvious, that included studies greater heterogeneity between groups was statistically significant the difference, using the random effect model combined with analysis; (2) I2=92%, NPDR group and NDR group and the effect of contrast p=0.07, sensitivity analysis after I250%, heterogeneity, using a random effects model with the amount of data; (3) PDR group and NDR group and the effect of post contrast I2=97%, p=0.02, sensitivity after analysis I250%, heterogeneity, using a random effects model with the amount of data; (4) PDR group and NPDR group and the effect of contrast and effect of each combination is compared after I2=87%, p=0.01, I250%, sensitivity analysis, heterogeneity, the random effects model with data. The results of quality evaluation of literature according to the inclusion of type using the NOS evaluation standard, the literature quality evaluation for the medium. The combined effect of the amount of results showed that in comparison with DR group and NDR group in the overall data, patients in group DR two D- dimer with an average level of 0.99 times in group NDR, 95% confidence interval (CI) [0.12,1.85]. subgroup analysis in NPDR group, two D- dimer the average level of NDR group was 0.67 times, 95%CI[-0.06,1.39]; group PDR two D- dimer level is NDR group 1.82 times, 95%CI[0.24,3.40].PDR group and NPDR group compared with PDR group, two D- dimer 0.96 times the average level of NDR group, 95%CI[group and NDR group compared to 0.22,1.69].NPDR 95%CI was not statistically significant, and the rest of the combination effect of volume and 95%CI were statistically significant. The combined effect of the amount of total and sub combination and effect of the amount of tips in the patients with DR D- two to improve the level of D-dimer compared with NDR patients, especially in patients with PDR significantly increased the.STATA 12 software to generate the DR group and NDR group funnel, funnel icon asymmetric.Begg and Egger test results, p=0.3260.05, suggesting the study between the possibility of publication bias is low, the Meta analysis results are credible. Conclusion: 1. in patients with PDR two D- dimer level is NDR and NPDR in patients with.2. NDR and NPDR to improve the monitoring of plasma D- two level of D-dimer changes, help to improve the screening of PDR patients the rate and treatment rate, and is beneficial to the monitoring of disease development in patients with.3.DR two D- dimer in patients with DR may increase the body blood coagulation and fibrinolysis system abnormalities and inflammatory reaction.

【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R774.1

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