儿童致死性百日咳相关因素的Meta分析  

A meta analysis of associated factors for fatal pertussis in children

作　　者：赵艳[1] 尹丽娟 汤磊 ZHAO Yan;YIN Lijuan;TANG Lei(Department of Pediatrics,People's Hospital of Chongqing Banan District,Chongqing 401320,China;不详)

机构地区：[1]重庆市巴南区人民医院儿科,重庆401320 [2]重庆医科大学附属儿童医院

出　　处：《预防医学》2020年第11期1104-1110,共7页CHINA PREVENTIVE MEDICINE JOURNAL

摘　　要：目的系统评价儿童致死性百日咳的相关因素,为儿童致死性百日咳防治提供依据。方法检索中国知网、中国学术期刊数据库、中国生物医学文献数据库、Pubmed、Embase、Ovid、Web of Science等文献数据库,收集建库至2020年5月有关儿童致死性百日咳相关因素的分析性研究。采用加权均数差(WMD)或比值比(OR)评估儿童致死性百日咳的相关因素。结果检索文献5 418篇,纳入符合条件的文献16篇。Meta分析结果显示,女童(OR=1.36,95%CI:1.13~1.64)、出生体重低(WMD=-0.21,95%CI:-0.40^-0.03)、年龄小(WMD=-15.54,95%CI:-28.97^-2.10)、孕周短(WMD=-0.96,95%CI:-1.77^-0.16)、接种疫苗(OR=0.20,95%CI:0.11~0.36)、惊厥(OR=9.88,95%CI:6.94~14.08)、痉挛样咳嗽(OR=0.61,95%CI:0.47~0.78)、呼吸频率增快(WMD=10.68,95%CI:3.41~17.95)、心率增快(WMD=18.01,95%CI:7.33~28.69)、血氧饱和度降低(WMD=-5.38,95%CI:-10.36^-0.39)、白细胞计数升高(WMD=47.70,95%CI:40.95~54.46)、淋巴细胞计数升高(WMD=17.03,95%CI:11.00~23.07)、中性粒细胞计数升高(WMD=11.22,95%CI:6.04~16.40)、合并肺动脉高压(OR=37.99,95%CI:16.76~86.13)、发展成肺炎(OR=37.65,95%CI:27.85~50.90)、合并脑病(OR=23.38,95%CI:8.21~66.54)、合并任何并发症(OR=3.00,95%CI:1.73~5.23)、机械通气(OR=38.79, 95%CI:11.81~127.42)、气管插管(OR=297.36, 95%CI:46.20~1 913.98)、高频通气(OR=18.34,95%CI:8.46~39.75)、体外膜肺氧合(OR=47.49,95%CI:15.53~145.21)、吸入一氧化氮(OR=25.86,95%CI:8.52~78.43)、使用血管活性药物(OR=54.42,95%CI:15.71~188.45)、换血(OR=16.77,95%CI:6.53~43.09)与儿童致死性百日咳存在统计学关联。敏感性分析显示结果基本稳定。Egger’s检验显示痉挛样咳嗽、脑病、使用血管活性药物存在发表偏倚;Begg’s检验显示不存在发表偏倚。结论儿童致死性百日咳与性别、年龄、出生体重、孕周及多种临床症状体征有关,需早期识别和干预,并加强预防接种。Objective To learn the associated factors for fatal pertussis in children,so as to provide evidence for the prevention and treatment of fatal pertussis.Methods We searched Pubmed,Embase,Ovid,Web of Science,Wanfang Data,CNKI and CBM up to May of 2020 for the analytical studies about the associated factors for fatal pertussis in children,and used weighted mean difference(WMD) and odds ratio(OR) for a meta analysis.Results Finally 16 studies our of 5 418 preliminary ones were included.The meta analysis indicated that females(OR=1.36,95%CI:1.13-1.64),low birth weight(WMD=-0.21,95%CI:-0.40--0.03),young age(WMD=-15.54,95%CI:-28.97--2.10),small gestational age(WMD=-0.96,95%CI:-1.77--0.16),pertussis immunizations(OR=0.20,95%CI:0.11-0.36),seizures(OR=9.88,95%CI:6.94-14.08),spasmodic cough(OR=0.61,95%CI:0.47-0.78),increased respiratory rate(WMD=10.68,95%CI:3.41-17.95),increased heart rate(WMD=18.01,95%CI:733-28.69),decreased percent oxygen saturation(WMD=-5.38,95%CI:-10.36--0.39),increased white blood cell counts(WMD=47.70.95%CI:40.95-54.46),increased absolute lymphocyte counts(WMD=17.03,95%CI:11.00-23.07),increased absolute neutrophil counts(WMD=11.22,95%CI:6.04-16.40),pulmonary hypertension(OR=37.99,95%CI:16.76-86.13),pneumonia(OR=37.65,95%CI:27.85-50.90),encephalopathy(OR=23.38,95%CI:8.21-66.54),any comorbidity(OR=3.00,95%CI:1.73-5.23),mechanical ventilation(OR=38.19,95%CI:11.81-127.42),intubation(OR=297.36,95%CI:46.20-1 913.98),high-frequency ventilation(OR=18.34,95%CI:8.46-39.75),extracorporeal membrane oxygenation(OR=47.49.95%CI:15.53-145.21),inhaled nitric oxide(OR=25.86,95%CI:8.52-78.43),use of vasoactive drugs(OR=54.42,95%CI:15.71-188.45) and blood exchange transfusion(OR=16.77,95%CI:6.53-43.09) were associated with fatal pertussis in children.The results of sensitivity analysis were stable.The results of Egger’s assay showed publication bias in studies about spasmodic cough,encephalopathy and use of vasoactive drugs,while Begg ’ s assay showed no publication bias at all.Conclusions Fatal pertussis in children

关 键 词：致死性百日咳 相关因素 儿童 META分析 

分 类 号：R725.6[医药卫生—儿科]