儿童过敏性紫癜复发相关危险因素的meta分析

Meta analysis of risk factors related to recurrence of henoch schonlein purpura in children

目的分析评价儿童过敏性紫癜(HSP)复发的相关危险因素。方法按照循证医学方法在PubMed、Web of Science、Cochrane Library、中国知网、万方数据库、维普数据库中检索2005年1月至2020年1月儿童HSP复发危险因素的相关队列研究及病例对照研究,依据纳入和排除标准,选择符合要求文献,对纳入文献进行文献质量评价,并提取相应观察指标(如年龄、性别、种族、发病季节、病程、临床表现、实验室检查、治疗药物等),采用RevMan 5.3软件对纳入文献相关指标进行meta分析。结果最终纳入文献26篇,6933例HSP患儿。meta分析结果显示:初次发病皮疹反复次数≥3次(OR=2.43,95%CI:1.26~4.68,P=0.008),初次发病伴关节肿痛(OR=1.77,95%CI:1.07~2.93,P=0.03),初次发病伴肾损害(OR=2.46,95%CI:1.61~3.76,P<0.0001),过敏原阳性(OR=7.74,95%CI:3.84~15.60,P<0.00001),初次治愈后呼吸道感染(OR=2.35,95%CI:1.58~3.49,P<0.0001),初次治愈后无预防用药(OR=5.35,95%CI:3.81~7.52,P<0.00001),初次治愈后未饮食控制(OR=2.14,95%CI:1.56~2.94,P<0.00001),初次治愈后未运动限制(OR=3.16,95%CI:2.08~4.78,P<0.00001)是儿童HSP复发的危险因素。亚组分析结果显示:在华裔人群中,使用糖皮质激素治疗(OR=72.34,95%CI:13.38~391.05,P<0.00001)、年龄较大(OR=2.66,95%CI:1.94~3.66,P<0.00001)、初次发病时严重腹痛(OR=2.19,95%CI:1.42~3.36,P=0.0004)为儿童HSP复发的危险因素;在非华裔人群中,使用糖皮质激素治疗(OR=2.26,95%CI:1.39~3.68,P=0.001)为HSP复发的危险因素。结论初次发病皮疹反复、伴关节肿痛、肾损害,过敏原阳性,初治愈后呼吸道感染、无预防用药、未饮食控制、未运动限制为儿童HSP复发的危险因素,年龄较大、使用糖皮质激素治疗、初次发病时严重腹痛HSP患儿复发情况在华裔、非华裔人群中存在差异。

Objective To systematically analyze the risk factors related to recurrence of henoch schonlein purpura(HSP)in children.Methods According to the method of evidence-based medicine,the relevant cohort study and case-control study on risk factors for HSP recurrence in children were searched in PubMed,Web of Science,Cochrane Library,CNKI,WanFang database and VIP database from January 2005 to January 2020.Based on inclusion and exclusion criterions,documents that meet the requirements were selected,the quality of the included literatures was evaluated,and the corresponding observation indicators(such as age,gender,race,onset season,course of disease,clinical manifestations,laboratory tests,therapeutic drugs,etc.)were extracted.The meta analysis was performed by RevMan 5.3 software.Results A total of 26 studies with 6933 HSP children were included.Meta analysis results showed that:the recurrent purpura(≥3 times)at first onset of the disease(OR=2.43,95%CI:1.26-4.68,P=0.008),joint swelling and pain at first onset of the disease(OR=1.77,95%CI:1.07-2.93,P=0.03),renal damage at first onset of the disease(OR=2.46,95%CI:1.61-3.76,P<0.0001),allergen positive(OR=7.74,95%CI:3.84-15.60,P<0.00001),respiratory tract infection after the first cure(OR=2.35,95%CI:1.58-3.49,P<0.0001),no preventive medication after the first cure(OR=5.35,95%CI:3.81-7.52,P<0.00001),no diet control after the first cure(OR=2.14,95%CI:1.56-2.94,P<0.00001),and no sport restriction after the first cure(OR=3.16,95%CI:2.08-4.78,P<0.00001)were risk factors for HSP recurrence in children.The subgroup analysis showed that:the risk factors in Chinese population were glucocorticoid therapy(OR=72.34,95%CI:13.38-391.05,P<0.00001),older age(OR=2.66,95%CI:1.94-3.66,P<0.00001)and severe abdominal pain at first onset of the disease(OR=2.19,95%CI:1.42-3.36,P=0.0004).The risk factors in non-Chinese population was glucocorticoid therapy(OR=2.26,95%CI:1.39-3.68,P=0.001).Conclusion The risk factors for the recurrence of children’s HSP are the recurrent purpura,joint swelling and pain and renal damage at the first onset of disease,allergen positive,respiratory tract infection,no preventive drugs,no diet control and no sport restriction after the first cure.The recurrence rates of HSP children with older age,use of Glucocorticoid therapy,severe abdominal pain af first onset of the disease were different between Chinese and non-Chinese groups.