乳腺癌相关上肢淋巴水肿危险因素荟萃分析

发布时间：2018-01-08 15:23

本文关键词：乳腺癌相关上肢淋巴水肿危险因素荟萃分析　出处：《苏州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:近年来许多研究探讨了乳腺癌治疗后导致淋巴水肿的危险因素,但结论并不一致,甚至部分结论相互矛盾。本研究采用系统评价方法分析乳腺癌治疗后,引起上肢淋巴水肿的危险因素及其关联强度,为临床工作中乳腺癌相关上肢淋巴水肿的早期预防提供科学依据。方法:本研究检索了Pub Med、Ovid、EMbase、Cochrane图书馆等英文数据库中从建库至2012年12月发表的临床研究,并检索纳入文献的参考文献以获取补充资料。检索词包括“Breast neoplasms”;“Upper extremity lymphedema”;“Risk factors”等。并按照纽卡斯尔渥太华规模(Newcastle Ottawa Scale,NOS)标准对纳入文献进行质量评价。应用Excel 2007建立数据库并初步运算,并采用Stata 10.0以及Rev Man 5.2软件进行数据分析,对各种危险因素的关联强度采用比值比(Odds Ratio,OR)及其95%可信区间(Confidence Intervals,CI)描述。各研究间的异质性采用I2检验评价。当各研究结果间有统计学同质性(P0.1,I2≤50%)时,采用固定效应模型进行分析;如各研究结果间存在统计学异质性(P0.1,I250%)时,则采用随机效应模型进行分析。发表偏倚采用Egger’s线性回归分析,P0.05为差异有统计学意义。结果:通过文献检索,最终纳入文献22篇,共包含10106例患者。按照纽卡斯尔渥太华规模(Newcastle Ottawa Scale,NOS)评价标准对纳入文献进行质量评价,其中22篇文献中有13篇被评为A级,9篇为B级,为较高质量文献。采用随机效应模型对危险因素进行合并分析,结果显示与乳腺癌治疗后上肢淋巴水肿相关因素主要为腋窝淋巴结清扫(OR=2.72,95%CI=1.06-6.99,P=0.038)、高血压(OR=1.84,95%CI=1.38-2.44,P=0.000)、体重指数(OR=1.68,95%CI=1.22-2.32,P=0.001)、放疗(OR=1.65,95%CI=1.20-2.25,P=0.002),而通过采用Stata 10.0以及Rev Man 5.2软件进行数据分析发现化疗、年龄、阳性淋巴结数目、淋巴结清扫数目等因素与乳腺癌治疗后上肢淋巴水肿的发生并没有明显相关性。结论:乳腺癌治疗后上肢淋巴水肿具有较高的发病率,不同研究报道其差异较大,本文纳入文献报道的发病率为0.6%-60.4%。通过系统评价分析发现腋窝淋巴结清扫、高血压、体重指数、放疗是乳腺癌治疗后淋巴水肿的主要危险因素。
[Abstract]:Objective: in recent years, many studies have examined the risk of breast cancer after the treatment of lymphedema factors, but the conclusion is not consistent, and even some conclusions are contradictory. This research adopts system analysis and assessment method of breast cancer after treatment, and the strength of the correlation between risk factors for upper extremity lymphedema, provide scientific basis for early breast cancer related clinical work the upper limb lymphedema prevention. Methods: We searched the Pub Med, Ovid, EMbase, clinical research published from inception to December 2012 Cochrane English library database, and retrieval into literature references to obtain additional information. The key words of "Breast neoplasms"; "Upper extremity lymphedema"; "Risk factors". And in accordance with the Newcastle Ottawa scale (Newcastle Ottawa Scale, NOS) standard to evaluate the quality of the included literature. By using Excel 2007 The database and preliminary calculation, and the data were analyzed by Stata 10 and Rev Man 5.2 software, the strength of the correlation of various risk factors using the odds ratio (Odds Ratio, OR) and 95% confidence interval (Confidence, Intervals, CI). I2 test was used to evaluate the heterogeneity between the studies. When the result was statistically significant among homogeneity (P0.1, I2 = 50%), using fixed effect model analysis; there is statistical heterogeneity as the research results (P0.1, I250%), the random effects model analysis. Publication bias by Egger 's P0.05 linear regression analysis, the difference was statistically significant. Results: through literature retrieval. Finally 22 articles were included, contains a total of 10106 patients. According to the Newcastle Ottawa scale (Newcastle Ottawa Scale, NOS) evaluation criteria to evaluate the quality of the included literatures, including 22 articles in 13 was named A 9 grade, B grade, high quality literature. By using the random effect model combined with analysis of the risk factors, results and related factors of upper limb lymphedema after breast cancer treatment for axillary lymph node dissection (OR=2.72,95%CI=1.06-6.99, P=0.038), hypertension (OR= 1.84,95%CI=1.38-2.44, P=0.000), body mass index (OR=1.68,95%CI=1.22-2.32, P=0.001). Radiotherapy (OR=1.65,95%CI=1.20-2.25, P=0.002), and the data analysis showed that chemotherapy, by using Stata 10 and Rev Man 5.2 software age, the number of positive lymph nodes, lymph node clearing all orders and other factors of breast cancer after treatment of lymphedema occurs and there is no obvious correlation. Conclusion: breast cancer treatment of upper limb lymphedema after high the incidence of different reports on the differences, this paper included the incidence rate of 0.6% reported -60.4%. through the analysis of the evaluation system that axillary Lymph node dissection, hypertension, body mass index, and radiotherapy are the main risk factors for lymphedema after treatment of breast cancer.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9

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