幼年特发性关节炎患儿血管内皮功能的系统评价和meta分析

doi:10.3969/j.issn.1004-583X.2022.03.002

摘要/Abstract

摘要：

目的通过系统评价肱动脉血流介导的血管舒张(flow mediated dilation, FMD)功能与幼年特发性关节炎患儿(juvenile idiopathic arthritis, JIA)的相关性,探讨JIA患儿的血管内皮功能。方法计算机检索Pubmed、Embase、Web of Science、The Cochrane Library、CNKI、WangFang Date、VIP数据库和CBM,搜集FMD与JIA患儿相关性的病例对照研究和横断面研究,检索时间为建库至2020年8月。由2名参与人员独立地进行文献筛选、资料提取、偏倚风险评估后,采用Reviewer Manager 5.3 及Stata 16软件进行meta分析。结果共纳入10篇文献,6个病例对照研究,4个横断面研究,包括JIA患儿439例,健康对照组382例。Meta分析结果显示:与健康对照组比,JIA患儿的FMD值明显降低(WMD=-3.51,95%CI=-4.16~-2.85,P<0.01)。亚组分析显示:与健康对照组相比,多关节型、少关节型、全身型JIA患儿的FMD值显著降低(WMD_多关节型JIA=-3.30, 95%CI=-4.51~-2.09, P<0.01;WMD_少关节型JIA=-2.39, 95%CI=-3.63~-1.15, P=0.0002; WMD_全身型JIA=-2.02, 95%CI=-2.57~-1.48, P<0.01)。结论 JIA患儿存在血管内皮功能障碍。

关键词: 关节炎,青少年, 肱动脉血流介导的血管舒张, 血管内皮功能, Meta分析

Abstract:

Objective To assess the correlation between brachial artery flow mediated dilatation (FMD) and juvenile idiopathic arthritis (JIA) by systematic review, and to explore vascular endothelial function in JIA children fatherly. Methods A case-control and cross-sectional studies regarding FMD and JIA children were conducted to collect via Computer retrieval of PubMed, Embase, Web of Science, The Cochrane Library, CNKI, WangFang Date, VIP databases and CBM, the retrieval time is from the establishment of database to August 2020. The literature screening, data extraction and bias risk assessment were independently conducted by two participants, meta-analysis was performed using Reviewer Manager 5.3 and Stata 16 software. Results There were 10 literature, 6 case-control studies, and 4 cross-sectional studies including 439 JIA children and 382 healthy controls (control group). The results of meta analysis verified that FMD value of JIA children was significantly lower than that of healthy children in the control group (weight mean difference [WMD]=-3.51, 95%CI=-4.16, -2.85, P<0.01, respectively); the subgroup analysis showed that FMD values of JIA children with polyarticular, oligoarticular, and systemic were significantly lower than those in the control group (WMD polyarticular JIA=-3.30, 95%CI=-4.51, -2.09, P<0.01; WMD oligoarticular JIA=-2.39, 95%CI=-3.63, -1.15, P=0.0002; WMD systemic JIA=-2.02, 95%CI=-2.57, -1.48, P<0.01, respectively). Conclusion Children with JIA retain vascular endothelial dysfunction.

Key words: arthritis,juvenile, brachial artery flow-mediated dilation, endothelial function, Meta analysis

中图分类号:

R593.22

胡芳芳, 钟世玲, 狄亚珍, 吴菱. 幼年特发性关节炎患儿血管内皮功能的系统评价和meta分析[J]. 临床荟萃, 2022, 37(3): 204-210.

Hu Fangfang, Zhong Shiling, Di Yazhen, Wu Ling. Vascular endothelial function of juvenile idiopathic arthritis in pediatric patients: A systematic review and meta-analysis[J]. Clinical Focus, 2022, 37(3): 204-210.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.03.002

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I3/204

图/表 7

参考文献 35

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纳入研究		国家		分型		病程 (年)		样本量(例)				年龄(岁)			性别(女,例)				BMI(kg/m²)
纳入研究		国家		分型		病程 (年)		病例组		对照组		病例组	对照组		病例组		对照组		病例组	对照组
Hussian 2021^[9]		印度		NA		3.67		81		78		12.17	13		31		34		16.73	18.53
Ebraheem 2019^[10]		埃及		oJIA pJIA sJIA		4		55		30		10.9	9.7		28		NA		18.6	18.5
孙东明 2019^[11]		中国		pJIA RF(+)		0.44		17		23		9.2	9.1		8		11		NA	NA
孙东明 2019^[11]		中国		pJIA RF(-)		0.41		25		23		8.9	9.1		11		11		NA	NA
Turoňová 2018^[12]		斯洛伐克		PSA		5.48		25		25		13.91	14.01		NA		NA		NA	NA
Ali 2016^[13]		埃及		NA		4.7		30		50		12.1	11.9		30		24		19.9	20.9
Rusak 2015^[14]		波兰		NA		3.76		25		11		11.33	12.67		12		7		19.05	18.72
Amar 2015^[15]		埃及		oJIA pJIA sJIA		4.6		42		42		13	13.1		24		22		19.6	20
Satija 2014^[16]		印度		oJIA pJIA sJIA ERA		3.097		31		31		10.27	10.27		18		18		15.18	15.91
Głowińska-Olszewska 2013^[17]		波兰		NA		3.83		58		36		13.0	13.4		32		22		20.6	19.1
Vlahos 2011^[18]		希腊		oJIA pJIA sJIA		6.58		30		33		12	12		21		21		19.9	18.9
纳入研究	TC(mg/dl)				HDL-C(mg/dl)				LDL-C(mg/dl)					TG(mg/dl)				控制混杂因素			评分
纳入研究	病例组		对照组		病例组		对照组		病例组		对照组			病例组		对照组		控制混杂因素			评分
Hussian 2021^[9]	166.83		155.67		37.67		50		106.9		82.73			110.5		110.07		①⑥			6
Ebraheem 2019^[10]	192		128.33		38.33		51.33		131.67		61.83			87		79.67		①②③⑤			8
孙东明 2019^[11]	133.02		134.96		35.58		48.72		85.46		82.37			104.52		37.90		⑤			7
孙东明 2019^[11]	129.54		134.96		45.63		48.72		80.82		82.37			77.95		37.90		⑤			7
Turoňová 2018^[12]	148.88		147.72		49.88		52.98		83.14		81.98			46.04		42.52		①②③⑥⑦			8
Ali 2016^[13]	NA		NA		NA		NA		NA		NA			NA		NA		①②			8
Rusak 2015^[14]	162		160.2		57.4		56		80.84		86.64			67		70.33		①④			5
Amar 2015^[15]	160.7		157.9		52.7		52.2		82.6		83.2			130.6		131		①			8
Satija 2014^[16]	120.93		123.81		34.61		37		65.19		64.26			99.71		93.2		①②③⑦			6
Głowińska-Olszewska 2013^[17]	157.39		153.52		54.14		55.3		82.37		80.05			68.2		64.6		①④			7
Vlahos 2011^[18]	164		165		51		56		98		96			71		64		①②③⑤⑥⑦			6

纳入研究		国家		分型		病程 (年)		样本量(例)				年龄(岁)			性别(女,例)				BMI(kg/m²)
纳入研究		国家		分型		病程 (年)		病例组		对照组		病例组	对照组		病例组		对照组		病例组	对照组
Hussian 2021^[9]		印度		NA		3.67		81		78		12.17	13		31		34		16.73	18.53
Ebraheem 2019^[10]		埃及		oJIA pJIA sJIA		4		55		30		10.9	9.7		28		NA		18.6	18.5
孙东明 2019^[11]		中国		pJIA RF(+)		0.44		17		23		9.2	9.1		8		11		NA	NA
孙东明 2019^[11]		中国		pJIA RF(-)		0.41		25		23		8.9	9.1		11		11		NA	NA
Turoňová 2018^[12]		斯洛伐克		PSA		5.48		25		25		13.91	14.01		NA		NA		NA	NA
Ali 2016^[13]		埃及		NA		4.7		30		50		12.1	11.9		30		24		19.9	20.9
Rusak 2015^[14]		波兰		NA		3.76		25		11		11.33	12.67		12		7		19.05	18.72
Amar 2015^[15]		埃及		oJIA pJIA sJIA		4.6		42		42		13	13.1		24		22		19.6	20
Satija 2014^[16]		印度		oJIA pJIA sJIA ERA		3.097		31		31		10.27	10.27		18		18		15.18	15.91
Głowińska-Olszewska 2013^[17]		波兰		NA		3.83		58		36		13.0	13.4		32		22		20.6	19.1
Vlahos 2011^[18]		希腊		oJIA pJIA sJIA		6.58		30		33		12	12		21		21		19.9	18.9
纳入研究	TC(mg/dl)				HDL-C(mg/dl)				LDL-C(mg/dl)					TG(mg/dl)				控制混杂因素			评分
纳入研究	病例组		对照组		病例组		对照组		病例组		对照组			病例组		对照组		控制混杂因素			评分
Hussian 2021^[9]	166.83		155.67		37.67		50		106.9		82.73			110.5		110.07		①⑥			6
Ebraheem 2019^[10]	192		128.33		38.33		51.33		131.67		61.83			87		79.67		①②③⑤			8
孙东明 2019^[11]	133.02		134.96		35.58		48.72		85.46		82.37			104.52		37.90		⑤			7
孙东明 2019^[11]	129.54		134.96		45.63		48.72		80.82		82.37			77.95		37.90		⑤			7
Turoňová 2018^[12]	148.88		147.72		49.88		52.98		83.14		81.98			46.04		42.52		①②③⑥⑦			8
Ali 2016^[13]	NA		NA		NA		NA		NA		NA			NA		NA		①②			8
Rusak 2015^[14]	162		160.2		57.4		56		80.84		86.64			67		70.33		①④			5
Amar 2015^[15]	160.7		157.9		52.7		52.2		82.6		83.2			130.6		131		①			8
Satija 2014^[16]	120.93		123.81		34.61		37		65.19		64.26			99.71		93.2		①②③⑦			6
Głowińska-Olszewska 2013^[17]	157.39		153.52		54.14		55.3		82.37		80.05			68.2		64.6		①④			7
Vlahos 2011^[18]	164		165		51		56		98		96			71		64		①②③⑤⑥⑦			6

协变量	回归系数	95%CI	t值	P值
年龄	-0.503	-0.577~0.476	-0.22	0.834
性别	3.309	-6.162~12.780	0.79	0.450
样本量	-0.018	-0.59~0.023	-0.99	0.347
研究类型	-0.247	-0.217~1.676	-0.29	0.778
病程	0.076	-0.356~0.509	0.40	0.700
HDL-C	0.071	-0.037~0.179	1.51	0.169
LDL-C	-0.027	-0.082~0.026	-1.17	0.274
TG	-0.124	-0.050~0.025	-0.76	0.472
TC	-0.144	-0.065~0.036	-0.66	0.528

协变量	回归系数	95%CI	t值	P值
年龄	-0.503	-0.577~0.476	-0.22	0.834
性别	3.309	-6.162~12.780	0.79	0.450
样本量	-0.018	-0.59~0.023	-0.99	0.347
研究类型	-0.247	-0.217~1.676	-0.29	0.778
病程	0.076	-0.356~0.509	0.40	0.700
HDL-C	0.071	-0.037~0.179	1.51	0.169
LDL-C	-0.027	-0.082~0.026	-1.17	0.274
TG	-0.124	-0.050~0.025	-0.76	0.472
TC	-0.144	-0.065~0.036	-0.66	0.528