本文選題：糖尿病視網(wǎng)膜病變 + D-二聚體　； 參考：《廣州醫(yī)科大學》2017年碩士論文

【摘要】：目的通過對國內外2型糖尿病患者中DR與NDR患者血漿D-二聚體水平,以及糖網(wǎng)病變程度與其相關性的觀察性研究進行Meta分析,探討D-二聚體與糖尿病視網(wǎng)膜病變的相關性,為臨床診治提供依據(jù)。資料和方法計算機檢索Pubmed、Cochrane Library、PMC、萬方數(shù)據(jù)庫、維普等全文數(shù)據(jù)庫,中文檢索詞為“糖尿病視網(wǎng)膜病變”、“D-二聚體”、“二聚體”,英文檢索詞為“diabetic retinopathy”、“diabetes retina”、“d-dimer”和“D-D”,檢索時間至2017年3月。共檢索得出相關文獻156篇,其中包括Pubmed 12篇,萬方數(shù)據(jù)庫42篇,PMC 83篇,維普數(shù)據(jù)庫19篇,Cochrane Library 0篇。依據(jù)提前設定的納入及排除標準,使用Note Express軟件進行文獻篩選,對全部潛在文獻進行全文檢索,其中3篇文獻未檢索到全文,予以排除,剩余文獻31篇。閱讀全文文獻后排除無明確診斷分組文獻1篇,文獻記錄數(shù)據(jù)與原文結論不符文獻1篇,存在研究數(shù)據(jù)重復發(fā)表可能文獻1篇,缺少NDR對照組文獻1篇,缺少可提取數(shù)據(jù)1篇,缺少明確分組指標文獻1篇,未排除全身重大疾病如心腦血管、肝腎、腫瘤、妊娠、代謝、急慢性炎癥或影響凝血、纖溶系統(tǒng)藥物服用史文獻19篇。剩余初步納入文獻共計6篇.對納入文獻進行證據(jù)評級、質量評價和數(shù)據(jù)提取。6篇研究提取病例組、對照組的樣本量,D-二聚體測量水平均數(shù)及標準差作為合并統(tǒng)計量,病例組(DR組)合并樣本量為391例,對照組(NDR組)合并樣本量為353例,4篇進行DR組亞組分型的研究中,中NPDR組合并樣本量為182例,PDR組合并樣本量為114例。各研究間度量衡單位不一致,采用標準化均數(shù)差(SMD)表示結果。結果如下:(1)經(jīng)異質性檢驗,DR組與NDR組合并效應量對比后的I2=96%,p=0.03,敏感性分析顯示逐一去除各項研究后異質性I2均大于50%,敏感性分析不明顯,提示納入研究異質性較大,組間差異有統(tǒng)計學意義,采用隨機效應模型進行合并分析;(2)NPDR組與NDR組合并效應量對比后的I2=92%,p=0.07,行敏感性分析后I250%,異質性較大,采用隨機效應模型合并數(shù)據(jù)量;(3)PDR組與NDR組合并效應量對比后I2=97%,p=0.02,敏感性分析后I250%,異質性較大,采用隨機效應模型合并數(shù)據(jù)量;(4)PDR組與NPDR組合并效應量對比后各組合并效應量對比后I2=87%,p=0.01,敏感性分析后I250%,異質性較大,采用隨機效應模型合并數(shù)據(jù)量。結果根據(jù)納入研究類型使用NOS評價標準進行文獻質量評價,納入文獻質量評價為中等。合并效應量結果顯示,在DR組和NDR組總體數(shù)據(jù)對比中,DR組患者D-二聚體平均水平為NDR組患者的0.99倍,95%置信區(qū)間(CI)[0.12,1.85]。亞組分析中,NPDR組D-二聚體平均水平為NDR組0.67倍,95%CI[-0.06,1.39];PDR組D-二聚體水平為NDR組1.82倍,95%CI[0.24,3.40]。PDR組與NPDR組間對比中,PDR組D-二聚體平均水平為NDR組0.96倍,95%CI[0.22,1.69]。NPDR組與NDR組對比95%CI無統(tǒng)計學意義,其余各組合并效應量及95%CI均有統(tǒng)計學意義�？偤喜⑿考皝喗M合并效應量提示在DR患者中D-二聚體水平較NDR患者提高,特別在PDR患者中提高更顯著。STATA 12.0軟件生成DR組與NDR組漏斗圖,漏斗圖示不對稱。Begg及Egger檢驗結果,p=0.3260.05,提示研究間發(fā)表偏倚存在可能性低,Meta分析結果較可信。結論1.在PDR患者中D-二聚體水平較NDR及NPDR患者提高。2.監(jiān)測NDR及NPDR血漿D-二聚體水平變化,有助于提高對PDR患者的篩出率及診治率,同時利于監(jiān)測病程發(fā)展。3.DR患者中D-二聚體升高可能與DR患者機體內凝血纖溶系統(tǒng)異常和炎癥反應有關。
[Abstract]:By DR and D- in plasma of patients with NDR at home and abroad in patients with type 2 diabetes and two level of D-dimer, and observational studies associated with the degree of sugar network lesions were analyzed by Meta, to investigate the correlation between D- two dimer and diabetic retinopathy, provide the basis for clinical diagnosis and treatment. Materials and methods of computer retrieval Pubmed, Cochrane Library, PMC, Wanfang database, VIP database, Chinese the key words of "diabetic retinopathy," D- two "dimer", "two dimers, English the key words of" diabetic retinopathy "," diabetes retina "," D-dimer "and" D-D ", the retrieval time to March 2017. Obtains the total 156 related articles, including Pubmed 12, Wanfang database 42, PMC 83, VIP database 19, Cochrane Library 0. According to the inclusion and exclusion criteria set in advance, the use of Note Express software For the screening of all the potential for full-text retrieval literature, including 3 articles were retrieved, excluded, the remaining 31 literatures. Read the literature after the exclusion of no clear diagnosis group 1 literature, literature data and record the original conclusion is inconsistent with 1 references of research data duplication may be 1 references the lack of NDR control group of 1 references, the lack of data can be extracted 1 articles, the lack of clear indicators of 1 articles, not to exclude systemic major diseases such as cardiovascular, kidney, cancer, pregnancy, metabolism, acute and chronic inflammation or affect blood coagulation, fibrinolysis system history of medicine taking 19 papers. The remaining initially included 6 articles altogether. Evidence rating of the literature, assessment and data extraction.6 study sample extraction quality of case group and control group, two D- dimer level measurement of mean and standard deviation as the combined statistics, case group (DR group) with sample size In 391 cases, the control group (group NDR) samples with 353 cases, 4 were DR group subgroup study, the combination of NPDR and sample of 182 cases, combination of PDR and sample of 114 cases. Between the various research units of measurement is not consistent with the standardized mean difference (SMD) said the results. The results are as follows: (1) after heterogeneity test, I2=96%, DR group and NDR combined effect is compared after p=0.03, sensitivity analysis showed that the removal of the heterogeneity of the study by I2 was greater than 50%, the sensitivity analysis is not obvious, that included studies greater heterogeneity between groups was statistically significant the difference, using the random effect model combined with analysis; (2) I2=92%, NPDR group and NDR group and the effect of contrast p=0.07, sensitivity analysis after I250%, heterogeneity, using a random effects model with the amount of data; (3) PDR group and NDR group and the effect of post contrast I2=97%, p=0.02, sensitivity after analysis I250%, heterogeneity, using a random effects model with the amount of data; (4) PDR group and NPDR group and the effect of contrast and effect of each combination is compared after I2=87%, p=0.01, I250%, sensitivity analysis, heterogeneity, the random effects model with data. The results of quality evaluation of literature according to the inclusion of type using the NOS evaluation standard, the literature quality evaluation for the medium. The combined effect of the amount of results showed that in comparison with DR group and NDR group in the overall data, patients in group DR two D- dimer with an average level of 0.99 times in group NDR, 95% confidence interval (CI) [0.12,1.85]. subgroup analysis in NPDR group, two D- dimer the average level of NDR group was 0.67 times, 95%CI[-0.06,1.39]; group PDR two D- dimer level is NDR group 1.82 times, 95%CI[0.24,3.40].PDR group and NPDR group compared with PDR group, two D- dimer 0.96 times the average level of NDR group, 95%CI[group and NDR group compared to 0.22,1.69].NPDR 95%CI was not statistically significant, and the rest of the combination effect of volume and 95%CI were statistically significant. The combined effect of the amount of total and sub combination and effect of the amount of tips in the patients with DR D- two to improve the level of D-dimer compared with NDR patients, especially in patients with PDR significantly increased the.STATA 12 software to generate the DR group and NDR group funnel, funnel icon asymmetric.Begg and Egger test results, p=0.3260.05, suggesting the study between the possibility of publication bias is low, the Meta analysis results are credible. Conclusion: 1. in patients with PDR two D- dimer level is NDR and NPDR in patients with.2. NDR and NPDR to improve the monitoring of plasma D- two level of D-dimer changes, help to improve the screening of PDR patients the rate and treatment rate, and is beneficial to the monitoring of disease development in patients with.3.DR two D- dimer in patients with DR may increase the body blood coagulation and fibrinolysis system abnormalities and inflammatory reaction.

【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.2;R774.1

【參考文獻】

相關期刊論文 前10條

1 康震;王寧;王芳;姚華強;;氟伐他汀聯(lián)合阿司匹林對糖尿病性下肢動脈硬化閉塞癥患者相關指標的影響[J];中國藥房;2017年06期

2 李會會;姜濤;文禎;;羥苯磺酸鈣輔助治療對老年2型糖尿病合并視網(wǎng)膜病變患者血清D-二聚體、同型半胱氨酸及C反應蛋白水平的影響[J];中國老年學雜志;2016年18期

3 徐曉宏;席志鳳;朱愛民;王軍升;;血漿D二聚體、纖維蛋白原在糖尿病腎病中的臨床價值分析[J];重慶醫(yī)學;2016年18期

4 李偉;;hs-CRP、sICAM-1、D-二聚體對2型糖尿病視網(wǎng)膜病變的診斷價值[J];國際檢驗醫(yī)學雜志;2016年11期

5 穆志靜;王立;;2型糖尿病視網(wǎng)膜病變凝血狀態(tài)研究[J];山西醫(yī)科大學學報;2016年03期

6 朱建軍;;膿毒血癥患者抗凝治療對凝血和炎性指標的影響研究[J];臨床醫(yī)學工程;2016年03期

7 鄭吉平;薛源;夏群;;2型糖尿病人D-二聚體、CRP監(jiān)測對糖尿病視網(wǎng)膜病變和腎病的臨床意義[J];中西醫(yī)結合心血管病電子雜志;2015年30期

8 張新芳;冉瑞金;;Eales病患者視網(wǎng)膜光凝治療前后血漿一氧化氮及一氧化氮合酶活性的變化[J];臨床眼科雜志;2015年04期

9 侯曉雯;時景璞;陳欣;;在Meta分析中如何利用中位數(shù)、極差和樣本量估算均數(shù)、標準差[J];中國循證醫(yī)學雜志;2015年04期

10 付廣真;徐冰;侯軍林;張曼;;2型糖尿病合并視網(wǎng)膜病變患者凝血功能分析[J];檢驗醫(yī)學與臨床;2015年07期

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