圆锥角膜发生危险因素的Meta分析

Risk factors for keratoconus:a Meta-analysis

目的采用二次文献分析法系统评价圆锥角膜发生的危险因素。方法检索Cochrane图书馆、PubMed、Embase数据库、中国知网、万方数据和维普中文科技期刊全文数据库自2000年1月起至2021年5月发表的与圆锥角膜发生和进展有关的高质量分析性研究设计文献,提取有效数据,采用纽卡斯尔-渥太华量表(NOS)对检索的病例对照和队列研究文献质量进行评价。分类指标的合并效应量采用比值比(OR)及其95%置信区间(CI),以Q检验和I^(2)检验评价文献中各结局指标的异质性,异质性分析P>0.1或I^(2)≤50%者采用固定效应模型进行分析;I^(2)>50%者采用随机效应模型并谨慎解释研究结果。采用亚组分析及敏感性分析法分析文献中评估指标的异质性来源。采用Egger检验、Harbord检验、Peters检验及漏斗图综合评价发表偏倚。结果共纳入21篇文献,包括病例对照研究18篇和队列研究3篇,研究资料来自10个国家,纳入圆锥角膜病例共30124例,对照者59012例,NOS评分均≥7分。Meta分析结果显示,家族史(OR:8.68,95%CI:6.30~11.97)、揉眼(OR:4.62,95%CI:3.75~5.70)、变态反应(OR:2.34,95%CI:1.73~3.16)、阻塞性睡眠呼吸暂停综合征(OR:1.53,95%CI:1.12~2.10)和唐氏综合征(OR:7.09,95%CI:4.19~11.99)是圆锥角膜的危险因素,糖尿病(OR:0.63,95%CI:0.50~0.79)为圆锥角膜的保护因素,二尖瓣脱垂非圆锥角膜的危险因素(P>0.05)。亚组分析结果显示,变态反应的异质性部分来源于具体疾病分类,糖尿病和阻塞性睡眠呼吸暂停综合征的异质性全部由病例来源产生;敏感性分析显示,改变分析模型后结果稳健。所纳入的文献间均无发表偏倚。结论家族史、揉眼、变态反应、阻塞性睡眠呼吸暂停综合征和唐氏综合征为圆锥角膜的危险因素,糖尿病为圆锥角膜的保护因素。

Objective To analyze the risk factors for keratoconus through a systematic review of secondary literature.Methods Analytical studies from Cochrane Library,PubMed,Embase database,CNKI,Wanfang Periodicals Database,VIP Chinese Science and Technology Journal Database published from January 2000 to May 2021 were searched,most of which were about the keratoconus occurrence and progression and the valid data were extracted.The case-control and the cohort studies were evaluated according to the Newcastle-Ottawa Scale.The categorical variables for combined effect size were odds ratio(OR)and 95%confidence interval(CI).The heterogeneity was evaluated via the Q test and I^(2) test.The fixed-effect model was adopted when P>0.1 or I^(2)≤50%,while the random effect model was adopted when I^(2)>50%.The sources of heterogeneity in included evaluation indexes were analyzed through subgroup and sensitivity analysis.The publication bias was evaluated by Egger tests,Harbord tests,Peters tests and funnel plots.Results A total of 21 papers with 30124 keratoconus cases and 59012 control cases enrolled,including 18 case-control studies and 3 cohort studies,whose data were from 10 countries,were included.The NOS scores of the studies were not less than 7 points.The Meta-analysis results indicated that family history(OR:8.68,95%CI:6.30-11.97),eye rubbing(OR:4.62,95%CI:3.75-5.70),allergy(OR:2.34,95%CI:1.73-3.16),obstructive sleep apnea(OR:1.53,95%CI:1.12-2.10)and Down syndrome(OR:7.09,95%CI:4.19-11.99)were the risk factors for keratoconus,and mitral valve prolapse(P>0.05)was not a risk factor for keratoconus,and diabetes(OR:0.63,95%CI:0.50-0.79)was a protective factor for keratoconus.The subgroup analysis results indicated that the heterogeneity in allergy was partially due to the specific disease classification,and the heterogeneity in diabetes and obstructive sleep apnea was totally owing to the source of the cases.The sensitivity study showed that the results were robust after changing the analysis model.There was no bias in the included studies.Conclusions Family history,eye rubbing,allergy,obstructive sleep apnea and Down syndrome are risk factors for keratoconus,and diabetes is a protective factor for keratoconus.