周雪晴　罗亚玲　周天津　黄仕鑫



·论著·

实验室指标与川崎病并发冠状动脉损伤关联性的系统评价和Meta分析

周雪晴罗亚玲周天津黄仕鑫

目的定量评估6项实验室指标与川崎病(KD)急性期并发冠状动脉损伤(CAL)的关联性，以期为早期判别KD并发CAL提供依据。方法 检索Web of Science、PubMed、Cochrane图书馆、EBSCO、中国知网、万方数据库和维普数据库，纳入6项实验室指标(WBC、Hb、PLT、CRP、ESR和ALB)与KD并发CAL相关性的病例对照研究文献，检索时间限定为2000年1月1日至2016年4月30日。以EndNote X7软件管理文献，依据纳入和排除标准筛选文献，以NOS量表评估纳入文献偏倚风险。提取各实验室指标与CAL关联的经多因素分析调整的OR及其95%CI，采用Stata 12.0软件行Meta分析，根据异质性结果选择相应的效应模型。结果12篇病例对照研究文献进入Meta分析，纳入4 900例KD患儿，发生CAL 1 256例。NOS量表评估结果，8篇文献评为7分，4篇文献评为6分。WBC、Hb、PLT、CRP、ESR和ALB与CAL相关性的Meta分析分别纳入2、3、8、3、4和5篇文献。WBC、Hb、CRP和ESR与CAL的发生无显著关联， OR(95%CI)分别为0.32(0.02～4.91)、0.94(0.88～1.01)、1.11(0.97～1.26)和1.09(0.98～1.20)。PLT和ALB与CAL的发生相关，随机效应模型汇总的OR(95%CI)分别为1.020(1.001～1.039)和0.87(0.80～0.95)。结论KD急性期ALB降低和PLT升高为发生CAL的危险因素。

川崎病；冠状动脉损伤；血小板；白蛋白；系统评价；Meta分析

AbstractObjective To explore the relationship between 6 common biomarkers and kawasaki disease (KD) with coronary artery lesions(CAL) in the acute phase.MethodsCase-control studies from the database of Web of Science, PubMed, The Cochrane Library, EBSCO, China National Knowledge Infrastructure, Wanfang Chinese Periodical Database and VIP Information were recruited to summarize the association between 6 biomarkers (WBC, Hb, PLT, CRP, ESR, ALB) with CAL from January 1 2000 to April 30 2016, and the biomarkers were adjusted by multivariate regression analysis. According to the inclusion and exclusion criteria the studies were selected through EndNote X7 software. The quality of the studies was evaluated by Newcastle-Ottawa Scale(NOS).Stata 12.0 software was applied for the meta-analysis, OR and 95%CI were extracted from each study. The effect model was selected according to the heterogeneity results.ResultsTwelve clinical studies with a total of 4 900 patients,1 256 patients with CAL were identified.6 factors were included . Six studies were 7 points and 4 studies were 6 points. There was no statistical significance between WBC, Hb, CRP, ESR with CAL, the results of OR and 95%CI were as follows: 0.32 (0.02-4.91), 0.94 (0.88-1.01), 1.11(0.97-1.26)and 1.09(0.98-1.20). PLT and ALB were related to the CAL, the results were as follows: 1.020(1.001-1.039) and 0.87(0.80-0.95). PLT and ALB were used as random model.ConclusionThe major risk factors for KD with CAL in the acute stage were increased PLT and decreased ALB.

关于川崎病(KD)并发冠状动脉损伤(CAL)危险因素的研究甚多，归纳起来，延误诊断、IVIG耐受、男性、年龄<1岁和发热持续时间长等均已明确为CAL的危险因素，但在KD急性期实验室指标与CAL关联性的报道不尽相同，且既往发表的相关Meta分析[1,2]采集的结局指标并未调整混杂因素。本文检索KD并发CAL的病例对照研究，以急性期6项常用的实验室指标(WBC、Hb、PLT、CRP、ESR和ALB)为拟考察的危险因素，定量评估上述指标与CAL发生的关系，以期为早期判别KD并发CAL提供依据。

1　方法

1.1文献纳入标准①病例对照研究；②研究对象年龄0～18岁；③KD的诊断标准参照文献[5]；④CAL的诊断依据超声心动图，且CAL诊断基于以下标准[4]：冠状动脉直径：<3岁，≥2.5 mm；～5岁，≥3 mm；>5岁，≥4 mm；或冠状动脉内径与冠状动脉根部内径之比>0.3；⑤本文考察KD急性期WBC、Hb、PLT、CRP、ESR和ALB中任意一项与CAL关联性；⑥提供了或通过数据可以计算出多因素分析调整后的影响因素OR及其95%CI；⑦……