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  本文選題：臨床孤立綜合征 + 多發(fā)性硬化�。� 參考：《山西醫(yī)科大學》2014年碩士論文

【摘要】：目的評價腦脊液（CSF）中CXCL13與臨床孤立綜合征（CIS）及多發(fā)性硬化（MS）的關(guān)系。 方法計算機檢索Pubmed（1966－2013）、Embase（1974－2013）、Ovid（1993-2013）、Cochrane中心臨床對照試驗注冊數(shù)據(jù)庫（CENTRAL）（2013年第四期）、中國生物醫(yī)學文獻數(shù)據(jù)庫（CBMdisc）（1978－2013）、CNKI（1979－2013）、VIP（1989－2013）以及萬方數(shù)據(jù)庫（1978－2013）等，收集關(guān)于CXCL13與臨床孤立綜合征及多發(fā)性硬化關(guān)系的隊列研究及病例對照研究。按Cochrane系統(tǒng)評價的方法，由2名研究人員分別對所納入的文獻進行獨立的質(zhì)量評價以及資料的提取和篩選，對文獻的數(shù)據(jù)進行Meta分析、定性評價。通過Cochrane協(xié)作網(wǎng)提供的RevMan5.2軟件進行Meta分析，通過對異質(zhì)性的檢驗來選擇固定效應(yīng)模型或隨機效應(yīng)模型，估計綜合評價指標95%的置信區(qū)間9，檢驗水準為α=0.05。 結(jié)果本研究共納入6篇的文獻，樣本量為1011例，其中病例組（多發(fā)性硬化及臨床孤立綜合征）為721例，對照組（神經(jīng)系統(tǒng)非炎性疾病[NND]）為290例。Meta分析研究結(jié)果顯示：（1）多發(fā)性硬化（MS）組與NND相比，MS組患者的CSF中CXCL13水平明顯升高（P0.00001）；（2）MS組與臨床孤立綜合征（CIS）組相比，MS組患者的CSF中CXCL13水平明顯升高（P0.00001）；（3）隨訪2年，轉(zhuǎn)化為MS的CIS組與未轉(zhuǎn)化的CIS組相比，轉(zhuǎn)化為MS的CIS組患者的CSF中CXCL13水平明顯升高（P=0.009）；（4）CSF中CXCL13水平10pg／mL的CIS組患者，轉(zhuǎn)化為MS的轉(zhuǎn)化率高于CSF中CXCL13水平10pg／mL的CIS組患者（P=0.0005）。 結(jié)論與NND組及CIS組相比，MS組的CSF中CXCL13水平明顯升高，與未轉(zhuǎn)化的CIS組相比，轉(zhuǎn)化為MS的CIS組的CXCL13水平明顯升高，且CIS患者CSF中CXCL13水平越高，MS的轉(zhuǎn)化率就越高，因此，CSF中CXCL13的水平與CIS及MS的發(fā)生發(fā)展有關(guān)，且對CIS轉(zhuǎn)歸為MS有重要的預(yù)測價值。本次Meta分析的納入研究相對偏少，納入的研究文獻質(zhì)量偏低，可能存在選擇性偏倚、信息偏倚和混雜偏倚，對結(jié)論的可靠性造成一定影響，，我們期待更多審計嚴謹?shù)母哔|(zhì)量流行病學研究對結(jié)果進行進一步驗證。
[Abstract]:Objective to evaluate the relationship between CXCL13 and clinical solitary syndrome (CISIS) and multiple sclerosis (MS) in cerebrospinal fluid (CSF). Methods computer search was conducted for Pubmedan (1966-2013) Embase (1974-2013) and Wanfang (1978-2013VIP1989-2013), and CENTRALL (2013 fourth issue, Chinese Biomedical Literature Database, 1978-2013VIP1989-2013) and Wanfang Database (1978-2013), respectively, for Cochrane Central Clinical controlled trial Registration Database (CENTRALL), China Biomedical Literature Database (CBMdisct) 1978-2013. Cohort studies and case-control studies on the relationship between CXCL13 and clinical solitary syndrome and multiple sclerosis were collected. According to the method of Cochrane system evaluation, two researchers carried out independent quality evaluation, data extraction and screening, Meta analysis and qualitative evaluation of the literature data. Through the Meta analysis of RevMan5.2 software provided by Cochrane cooperation network, the fixed effect model or random effect model is selected by testing the heterogeneity, and the confidence interval of 95% of the comprehensive evaluation index is estimated to be 9, and the test level is 偽 0.05. Results A total of 6 articles were included in this study. The sample size was 1011 cases, including 721 cases in the case group (multiple sclerosis and clinical solitary syndrome). A meta-analysis of 290 patients with neurological non-inflammatory diseases (NND). The results of Meta-analysis showed that the level of CXCL13 in CSF in the MS group was significantly higher than that in the NND group and that in the MS group was significantly higher than that in the MS group and the clinical isolated syndrome group. The level of CXCL13 in CSF was significantly increased (P 0.00001) and followed up for 2 years. Compared with the non-transformed CIS group, the CSF CXCL13 level in the CIS group was significantly higher than that in the non-transformed CIS group, and the CXCL13 level in the CIS group was significantly higher than that in the CIS group with the CXCL13 level in CSF, and the CXCL13 level in the 10pg/mL group was higher than that in the CIS group with the 10pg/mL level in the CSF. The level of CXCL13 in the CIS group was significantly higher than that in the CIS group with the 10pg/mL level in the CSF. Conclusion compared with NND group and CIS group, the level of CXCL13 in CSF in MS group was significantly higher, and the CXCL13 level in CIS group was significantly higher than that in untransformed CIS group, and the higher CXCL13 level in CIS patients was, the higher the transformation rate of MS was. Therefore, the level of CXCL13 in CSF is related to the occurrence and development of CIS and MS, and has important value in predicting the outcome of CIS to MS. The inclusion of Meta analysis is relatively small, the quality of the research literature is low, and there may be selective bias, information bias and mixed bias, which has a certain impact on the reliability of the conclusions. We look forward to further validation of the results by more rigorous and high-quality epidemiological studies.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R744.51

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本文編號：1779165