【摘要】：目的采用Meta分析的方法綜合評價中國人群卵巢早衰發(fā)病的危險因素和保護因素,并得出其關聯(lián)強度,為POF疾病的預防提供科學依據(jù),為進一步病因研究提供線索。方法通過計算機檢索Pub Med/MEDLINE、Embase、OVID、CBM、CNKI、萬方等數(shù)據(jù)庫,收集從2000年1月到2016年10月已發(fā)表的關于中國人群卵巢早衰的文獻,研究類型為病例對照研究,語種為中文或英文。根據(jù)制定的文獻納入和排除標準篩選文獻,用Meta分析方法進行綜合分析,效應量指標選用OR值和95%CI,采用Stata12.0軟件進行異質性檢驗、敏感性分析和發(fā)表偏倚的評估。結果最終納入27篇病例對照文獻,累計病例3249例,對照3119例。進行Meta分析結果如下:1 POF的危險因素及其關聯(lián)強度:家族史(OR=3.64)、腮腺炎病史(OR=7.71)、免疫性疾病史(OR=6.10)、盆腔炎病史(OR=2.67)、盆腔手術史(OR=4.92)、口服避孕藥(OR=4.17)、服用免疫類藥物(OR=3.86)、人工流產史(OR=3.68)、盆腔X線照射(OR=2.93)、月經不規(guī)律(OR=8.88)、離異或喪偶(OR=3.06)、吸煙(OR=4.38)、接觸有毒物質(OR=4.28)、節(jié)食減肥(OR=4.17)、染發(fā)(OR=3.91)、睡眠質量差(OR=2.75)、飲酒(OR=2.64)、精神創(chuàng)傷或異常(OR=8.60)、不良情緒(OR=5.30)、A型性格行為(OR=3.99)、生活壓力大(OR=2.72)、人際關系差(OR=1.59)。2 POF的保護因素及其關聯(lián)強度:心情愉悅(OR=0.18)、食用蔬菜(OR=0.33)、體育鍛煉(OR=0.36)、食用豆制品(OR=0.63)。3生育史、月經初潮早和美容三個因素的合并結果無統(tǒng)計學意義(P0.05),其與POF發(fā)病的關系尚不能確定。4敏感性分析結果顯示,異質性較大的因素I2值有不同程度的降低,但月經不規(guī)律、生育史、美容、體育鍛煉和食用豆制品五個因素的異質性仍較高。按剔除單因素作為條件進行敏感性分析結果提示果提示體育鍛煉單因素和多因素分析結果不一致,其余因素結果基本一致。5各研究因素經Egger’s法評估發(fā)表偏倚,發(fā)現(xiàn)食用豆制品因素可能存在發(fā)表偏倚。結論1 POF的危險因素有POF家族史、腮腺炎病史、免疫性疾病史、盆腔炎病史、盆腔手術史、口服避孕藥、服用免疫類藥物、人工流產史、盆腔X線照射、離異或喪偶、吸煙、接觸有毒物質、節(jié)食減肥、染發(fā)、睡眠質量差、飲酒、精神創(chuàng)傷或異常、不良情緒、A型性格行為、生活壓力大、人際關系差。POF的保護因素有心情愉悅和食用蔬菜。2月經不規(guī)律、月經初潮早、生育史、美容、體育鍛煉和食用豆制品六個研究因素與POF發(fā)病的關系尚不能確定,需更多數(shù)據(jù)進一步探討。3臨床上可以應用這些結論指導婦女健康教育,從而預防或延緩POF的發(fā)生和發(fā)展。
[Abstract]:Objective to evaluate the risk factors and protective factors of premature ovarian failure (POF) in Chinese population by means of Meta analysis, and to obtain its association strength, so as to provide scientific basis for the prevention of POF disease and provide clues for further etiological study. Methods Pub Med/MEDLINE,Embase,OVID,CBM,CNKI, Wanfang database was searched by computer to collect the published literatures on premature ovarian failure in Chinese population from January 2000 to October 2016. The type of study was a case-control study. The language is Chinese or English. According to the criteria of inclusion and exclusion, the comprehensive analysis was carried out by using Meta analysis method. The OR value and 95% CI were selected as the index of effect quantity, and the heterogeneity test, sensitivity analysis and publication bias evaluation were carried out by Stata12.0 software. Results 3249 cases and 3119 cases were included in 27 case-control literatures. The results of Meta analysis were as follows: 1 the risk factors and their association strength of POF: family history (OR=3.64), history of mumps (OR=7.71), history of immunological diseases (OR=6.10), history of pelvic inflammatory disease (OR=2.67). History of pelvic surgery (OR=4.92), oral contraceptive (OR=4.17), taking immunopharmaceuticals (OR=3.86), history of induced abortion (OR=3.68), pelvic X-ray irradiation (OR=2.93), irregular menstruation (OR=8.88), Divorced or widowed (OR=3.06), smoking (OR=4.38), exposure to toxic substances (OR=4.28), dieting (OR=4.17), hair dyeing (OR=3.91), poor sleep quality (OR=2.75), drinking (OR=2.64), Traumatic or abnormal (OR=8.60), bad mood (OR=5.30), A personality behavior (OR=3.99), OR=2.72), OR=1.59. 2 the protective factors and their association strength of POF: OR=0.18, eating vegetables (OR=0.33), physical exercise (OR=0.36), eating soybean products (OR=0.63). 3 reproductive history. The combined results of the three factors of menarche and beauty were not statistically significant (P0.05), and the relationship between them and the onset of POF was uncertain. 4 the sensitivity analysis showed that the I2 value of the heterogeneity factor was decreased in varying degrees. But the heterogeneity of irregular menstruation, birth history, beauty, physical exercise and edible soybean products is still high. The results of sensitivity analysis under the condition of eliminating single factor indicated that the results of single factor exercise and multivariate analysis were inconsistent, and the results of other factors were basically consistent. 5 the publication bias was evaluated by Egger's method. It was found that there might be publication bias in edible soybean products. Conclusion 1 the risk factors of POF include family history of POF, history of mumps, history of immunological diseases, history of pelvic inflammatory disease, history of pelvic surgery, oral administration of contraceptive, taking of immune drugs, history of induced abortion, pelvic X-ray irradiation, divorce or widowhood, smoking. Exposure to toxic substances, diet, weight loss, hair dye, poor sleep quality, alcohol consumption, trauma or abnormality, bad mood, type A personality, high stress in life, Poor interpersonal relationships. The protective factors of POF are pleasure and eating vegetables, irregular menstruation, early menarche, birth history, beauty, physical exercise and eating soybean products. These conclusions can be used to guide women's health education in order to prevent or delay the occurrence and development of POF.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.75

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