儿童原发性肾病综合征并尿路感染危险因素Meta分析

The risk factors for urinary tract infection in children with primary nephrotic syndrome: a Meta - analysis

目的探讨儿童原发性肾病综合征(PNS)并尿路感染(UTI)的危险因素,为临床预防提供科学依据。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和中国生物医学文献数据库查找有关国内外儿童PNS伴UTI的病例对照研究,根据纳入、排除标准筛选文献,采用RevMan 5.3软件进行Meta分析。结果最终纳入12个病例对照研究,累计病例组917例,对照组2 784例。Meta分析结果显示:与非UTI儿童相比,PNS伴UTI患儿24 h尿蛋白升高[标准化均数差(SMD)=0.45,95%CI:0.02~0.88],血清清蛋白降低(SMD=-1.06,95%CI:-1.14^-0.97),血清胆固醇升高[加权均数差(MD)=2.28,95%CI:1.61~2.95],血清低密度脂蛋白(LDL)升高(SMD=0.57,95%CI:0.37~0.77),血IgG降低(SMD=-0.76,95%CI:-0.94^-0.58),血IgM升高(MD=0.28,95%CI:0.11~0.46),激素使用剂量大(MD=0.75,95%CI:0.58~0.92)和激素使用时间长[<15 d比值比(OR)=0.20,95%CI:0.10~0.42;≥15 d OR=5.00,95%CI:2.38~10.50]均有统计学意义。结论大量蛋白尿、低清蛋白血症、高胆固醇血症、高LDL血症、低IgG血症、大剂量激素和长时间使用激素是儿童PNS并UTI的危险因素。

Objective To systematically analyze the risk factors for urinary tract infection (UTI) in children with primary nephrotic syndrome (PNS), in order to provide scientific evidence for clinical prevention. Methods Eight databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Database, Chinese Science and Technology Periodical Database and Chinese Biological Medical Literature Database were retrieved for the case-control studies on PNS complicated with UTI in children.According to the inclusion and exclusion criteria, eligible studies were selected for meta-analysis by using RevMan 5.3 software. Results Finally, 12 case-control studies were included, 917 children in the case group and 2 784 children in the control group.Compared with children without UTI, statistically significant difference existed in children with UTI of elevated 24-hour urine protein [standardized mean difference (SMD)=0.45, 95% CI: 0.02-0.88], decreased serum albumin (SMD=-1.06, 95%CI:-1.14--0.97), elevated serum cholesterol [weighted mean difference (MD)=2.28, 95%CI: 1.61-2.95], elevated serum low density lipoprotein (SMD=0.57, 95%CI: 0.37-0.77), decreased plasma IgG (SMD=-0.76, 95%CI:-0.94 to-0.58), elevated plasma IgM (MD=0.28, 95%CI: 0.11-0.46), high-dose hormone (MD=0.75, 95%CI: 0.58-0.92), and long time hormone use[<15 d odds ratio (OR)=-0.20, 95%CI: 0.10-0.42;≥15 d OR=5.00, 95%CI: 2.38-10.50]. Conclusions Massive proteinuria, hypoalbuminaemia, hypercholesterolemia, high level of low density lipoprotein, decreased plasma IgG, high-dose hormone and long time hormone use are risk factors for UTI in children with PNS.