【摘要】：目的:運用R軟件進(jìn)行meta分析,綜合評價中國兒童感染性心內(nèi)膜炎(infective endocarditis,IE)的臨床特點、并發(fā)癥、實驗室檢查、贅生物位置、治療及結(jié)局。方法:檢索萬方數(shù)據(jù)庫、維普信息資源系統(tǒng)、中國知網(wǎng)期刊全文數(shù)據(jù)庫以及Pub Med數(shù)據(jù)庫,收集2016年3月之前所有關(guān)于兒童感染性心內(nèi)膜炎的文獻(xiàn),再從中篩選出符合納入標(biāo)準(zhǔn)的單中心橫斷面研究。使用R軟件對兒童IE的臨床特點、并發(fā)癥、實驗室檢查、贅生物位置、治療及結(jié)局各事件進(jìn)行率的綜合分析,合并前先行進(jìn)行異質(zhì)性檢驗,根據(jù)結(jié)果以確定采用固定模型或隨機(jī)模型進(jìn)行率的合并,然后運用Egger檢驗進(jìn)行發(fā)表偏倚的評估,利用meta回歸和亞組分析評估異質(zhì)性來源。結(jié)果:本研究共納入相關(guān)文獻(xiàn)16篇,病例數(shù)892例,男童的合并率為55%(95%CI:51%-58%)。IE絕大多數(shù)具有潛在基礎(chǔ)心臟疾病,先天性心臟病(CHD)的合并率為68%(95%CI:62%-72%),其中室間隔缺損(VSD)為33%(95%CI:27%-40%);風(fēng)濕性心臟病(RHD)的合并率為10%(95%CI:7%-14%)。最常見的臨床表現(xiàn)為發(fā)熱,合并率為89%(95%CI:84%-93%),其他包括脾腫大、雜音改變及皮膚瘀斑、瘀點等。并發(fā)癥中栓塞的合并率為22%(95%CI:19%-26%),心力衰竭的合并率為45%(95%CI:34%-56%)。病原學(xué)檢查中,革蘭氏陽性菌(G+菌)的合并率為87%(95%CI:83%-90%),其中最常見的是金黃色葡萄球菌,其次為草綠色鏈球菌;革蘭氏陰性菌(G-菌)為9%(95%CI:7%-13%),真菌為5%(95%CI:3%-8%),HACEK菌罕見。贅生物檢出陽性的合并率為78%(95%CI:67%-86%),累積左心與右心的合并率分別為60%(95%CI:43%-75%)和33%(95%CI:21%-48%)。手術(shù)治療的合并率為21%(95%CI:13%-32%),合并死亡率為14%(95%CI:10%-18%)。各地區(qū)的死亡率有差異,國內(nèi)華中的合并死亡率高于華南。結(jié)論:小兒IE是罕見且具有死亡威脅的疾病。我國兒童IE的死亡率高,并且具有地區(qū)差異,積極預(yù)防對降低死亡率有幫助。IE最常見的潛在心臟疾病是CHD,但RHD仍為重要危險因素;最主要的致病菌為金黃色葡萄球菌,贅生物最常累積的部位為左心。IE的臨床表現(xiàn)越來越不典型,早期診斷依賴于血培養(yǎng)及超聲檢查。
[Abstract]:Objective: to evaluate the clinical features, complications, laboratory findings, vegetative location, treatment and outcome of infective endocarditis (infective endocarditis,IE) in Chinese children by using R software for meta analysis. Methods: to search Wanfang database, Weipu information resource system, full text database of Chinese journal and Pub Med database, and collect all the literatures about infective endocarditis in children before March 2016. A single center cross-sectional study which meets the inclusion criteria was selected from the study. R software was used to analyze the clinical characteristics, complications, laboratory examination, vegetative location, treatment and outcome of IE in children. The results were used to determine the combination of rates using a fixed model or a random model, and then Egger test was used to evaluate publication bias, and meta regression and subgroup analysis were used to evaluate the heterogeneity source. Results: a total of 16 related literatures were included in this study, 892 cases were included in the study. The rate of boys' merger was 55% (95% CI: 51% -58%) with underlying heart disease, most of them had underlying heart disease. The combined rate of congenital heart disease (CHD) was 68% (95 CI: 62-72%), and (VSD) of ventricular septal defect (VSD) was 33% (95 CI: 27- 40%). The combined rate of rheumatic heart disease (RHD) was 10% (95% CI: 7-14%). The most common clinical manifestation was fever, with a combined rate of 89% (95 CI: 84-93%), including splenomegaly, murmur and skin ecchymosis, stasis points, etc. The combined rate of embolism was 22% (95 CI: 19-26%) and heart failure was 45% (95 CI: 34-56%). The combined rate of Gram-positive bacteria (G) was 87% (95 CI: 83-90%), among which Staphylococcus aureus was the most common, followed by Streptococcus grass green. Gram-negative bacteria (G- bacteria) were 9% (95% CI: 7- 13%), fungi were 5% (95% CI: 3 -8%), HACEK). The positive rate was 78% (95 CI: 67-86%), the combined rate of accumulated left heart and right heart was 60% (95 CI: 43 -75%) and 33% (95 CI: 21 -48%). The combined rate of surgical treatment was 21% (95% CI: 13-32%) and the combined mortality rate was 14% (95 CI: 10% -18%). The mortality rate of central China is higher than that of South China. Conclusion: IE is a rare and death threatening disease in children. The mortality rate of IE in children in China is high and there are regional differences. Active prevention is helpful to reduce mortality. CHD, is the most common latent heart disease in IE but RHD is still an important risk factor. Staphylococcus aureus is the main pathogenic bacteria and the most common accumulation of vegetations is left heart. The clinical manifestations of IE are becoming more and more atypical. Early diagnosis depends on blood culture and ultrasound examination.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R725.4

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