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(xué)》2017年碩士論文

【摘要】：目的通過(guò)對(duì)國(guó)內(nèi)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(guān)性的觀察性研究進(jìn)行Meta分析,探討D-二聚體與糖尿病視網(wǎng)膜病變的相關(guān)性,為臨床診治提供依據(jù)。資料和方法計(jì)算機(jī)檢索Pubmed、Cochrane Library、PMC、萬(wàn)方數(shù)據(jù)庫(kù)、維普等全文數(shù)據(jù)庫(kù),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(shí)間至2017年3月。共檢索得出相關(guān)文獻(xiàn)156篇,其中包括Pubmed 12篇,萬(wàn)方數(shù)據(jù)庫(kù)42篇,PMC 83篇,維普數(shù)據(jù)庫(kù)19篇,Cochrane Library 0篇。依據(jù)提前設(shè)定的納入及排除標(biāo)準(zhǔn),使用Note Express軟件進(jìn)行文獻(xiàn)篩選,對(duì)全部潛在文獻(xiàn)進(jìn)行全文檢索,其中3篇文獻(xiàn)未檢索到全文,予以排除,剩余文獻(xiàn)31篇。閱讀全文文獻(xiàn)后排除無(wú)明確診斷分組文獻(xiàn)1篇,文獻(xiàn)記錄數(shù)據(jù)與原文結(jié)論不符文獻(xiàn)1篇,存在研究數(shù)據(jù)重復(fù)發(fā)表可能文獻(xiàn)1篇,缺少NDR對(duì)照組文獻(xiàn)1篇,缺少可提取數(shù)據(jù)1篇,缺少明確分組指標(biāo)文獻(xiàn)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(xiàn)19篇。剩余初步納入文獻(xiàn)共計(jì)6篇.對(duì)納入文獻(xiàn)進(jìn)行證據(jù)評(píng)級(jí)、質(zhì)量評(píng)價(jià)和數(shù)據(jù)提取。6篇研究提取病例組、對(duì)照組的樣本量,D-二聚體測(cè)量水平均數(shù)及標(biāo)準(zhǔn)差作為合并統(tǒng)計(jì)量,病例組(DR組)合并樣本量為391例,對(duì)照組(NDR組)合并樣本量為353例,4篇進(jìn)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(biāo)準(zhǔn)化均數(shù)差(SMD)表示結(jié)果。結(jié)果如下:(1)經(jīng)異質(zhì)性檢驗(yàn),DR組與NDR組合并效應(yīng)量對(duì)比后的I2=96%,p=0.03,敏感性分析顯示逐一去除各項(xiàng)研究后異質(zhì)性I2均大于50%,敏感性分析不明顯,提示納入研究異質(zhì)性較大,組間差異有統(tǒng)計(jì)學(xué)意義,采用隨機(jī)效應(yīng)模型進(jìn)行合并分析;(2)NPDR組與NDR組合并效應(yīng)量對(duì)比后的I2=92%,p=0.07,行敏感性分析后I250%,異質(zhì)性較大,采用隨機(jī)效應(yīng)模型合并數(shù)據(jù)量;(3)PDR組與NDR組合并效應(yīng)量對(duì)比后I2=97%,p=0.02,敏感性分析后I250%,異質(zhì)性較大,采用隨機(jī)效應(yīng)模型合并數(shù)據(jù)量;(4)PDR組與NPDR組合并效應(yīng)量對(duì)比后各組合并效應(yīng)量對(duì)比后I2=87%,p=0.01,敏感性分析后I250%,異質(zhì)性較大,采用隨機(jī)效應(yīng)模型合并數(shù)據(jù)量。結(jié)果根據(jù)納入研究類(lèi)型使用NOS評(píng)價(jià)標(biāo)準(zhǔn)進(jìn)行文獻(xiàn)質(zhì)量評(píng)價(jià),納入文獻(xiàn)質(zhì)量評(píng)價(jià)為中等。合并效應(yīng)量結(jié)果顯示,在DR組和NDR組總體數(shù)據(jù)對(duì)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(duì)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(duì)比95%CI無(wú)統(tǒng)計(jì)學(xué)意義,其余各組合并效應(yīng)量及95%CI均有統(tǒng)計(jì)學(xué)意義。總合并效應(yīng)量及亞組合并效應(yīng)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(duì)稱。Begg及Egger檢驗(yàn)結(jié)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(jié)果較可信。結(jié)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(cè)NDR及NPDR血漿D-二聚體水平變化,有助于提高對(duì)PDR患者的篩出率及診治率,同時(shí)利于監(jiān)測(cè)病程發(fā)展。3.DR患者中D-二聚體升高可能與DR患者機(jī)體內(nèi)凝血纖溶系統(tǒng)異常和炎癥反應(yīng)有關(guān)。
[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(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R587.2;R774.1

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