血清-腹水白蛋白梯度与肝硬化食管胃底静脉曲张破裂出血关系的Meta分析

Association between serum ascites albumin gradient and esophagogastric variceal bleeding in patients with liver cirrhosis: a Meta-analysis

目的探讨血清-腹水白蛋白梯度（SAAG）与肝硬化食管胃底静脉曲张破裂出血之间的关系。方法检索Pub Med、Embase、the Cochrane Library、万方、维普及CNKI数据库于2001年1月-2015年6月发表的所有有关SAAG与肝硬化食管胃底静脉曲张出血的中文文献,每篇文献均需设立出血组和未出血组。应用加强观察性流行病学研究报告质量为参考标准评价文献质量。合并各文献出血组和未出血组SAAG均数及标准差。采用Meta-Analyst软件计算每篇文献中出血组和未出血组SAAG标准化均值差（SMD）并进行Meta分析,多组间计数资料比较采用行×列χ2检验。结果共有13篇文献符合纳入标准。出血组SAAG为（22.54±4.69）g/L,未出血组SAAG为（15.91±4.20）g/L。异质性检验提示存在显著的异质性（Q=100.735,I2=89.065,P〈0.001）,出血组SAAG值显著高于未出血组,两组SAAG值差异有统计学意义（SMD=1.970,95%可信区间：1.425～2.515,P〈0.001）。根据SAAG水平分为SAAG〈15 g/L、15 g/L≤SAAG≤19.9 g/L和SAAG≥20 g/L 3组,随着SAAG水平的升高,3组发生静脉曲张破裂出血者的比例也逐渐升高,且差异有统计学意义（χ2=111.702,P〈0.001）。结论 SAAG与肝硬化食管胃底静脉曲张破裂出血存在密切关系。出血组SAAG水平显著高于未出血组。SAAG有望成为预测肝硬化食管胃底静脉曲张破裂出血的一种有价值指标。

Objective To investigate the association between serum ascites albumin gradient （SAAG） and esophagogastric variceal bleeding in patients with liver cirrhosis. Methods The databases PubMed, Embase, the Cochrane Library, Wanfang Data, VIP, and CNKI were searched to obtain Chinese articles on SAAG and esophagogastric varieeal bleeding in patients with liver cirrhosis published between January 2001 and June 2015, and each article should include a bleeding group and a non - bleeding group. Strengthening the reporting of observational studies in epidemiology （STROBE） was used as a reference to evaluate the quality of articles. The mean ± standard deviation （SD） of SAAG in bleeding groups and non -bleeding groups were pooled and analyzed. The Meta -Analyst software was used to calculate standardized mean differences （SMD） of SAAG between bleeding groups and non - bleeding groups and perform the meta - analysis. The chi - square test was applied for comparison of categorical data between groups. Results Thirteen articles met the inclusion criteria. SAAG was （22. 54 ± 4.69） g/L in bleed- ing groups and （ 15.91 ±4.20） g/L in non - bleeding groups. The test for heterogeneity showed significant heterogeneity （ Q = 100. 735,I2 = 89. 065, P 〈0. 001 ） , and the bleeding groups had a significantly higher SAAG than the non - bleeding groups （ SMD = 1. 970, 95% CI ： 1. 425 -2.515, P〈0.001）. According to the SAAG level, the patients were divided into the group with a SAAG of 〈 15 g/L, the group with a SAAG of ≥ 15 g/L and ≤ 19.9 g/L, and the group with a SAAG of ≥20 g/L, and with the increasing SAAG, the proportion of patients expe- riencing variceal bleeding increased significantly （X2 = 111. 702, P 〈 0. 001 ）. Conclusions SAAG is closely associated with esophagogastric variceal bleeding in patients with liver cirrhosis, and the bleeding groups have a higher SAAG than the non -bleeding groups. SAAG may be applied as a valuable indicator to predict esophagogastrie variceal bleeding in patients with liver cirrhosis.