【作者】 许亚平；

【导师】 赵平；

【作者基本信息】 吉林大学 ， 内科学（专业学位）， 2022， 硕士

【摘要】 目的:急性胰腺炎(Acute pancreatitis,AP)是临床上常见的急腹症,常见病因有高脂血症性、胆源性、病毒性及自身免疫性等,由于胰酶的异常激活对胰腺自身及周围器官产生消化作用而引起,常见临床表现为持续不缓解的腹痛,伴恶心、呕吐等。以胰腺自身的局部炎症反应为主,轻症可具有自限性,而发展至危重度时也可导致多器官功能障碍,危及生命。该疾病在国内外均有较高的发病率,给患者带来巨大的经济损失、身心痛苦,甚至造成死亡,因此早期评估病情及预测疾病的预后并及时采取相应的干预措施非常重要。现有的评估病情的标准,如一些综合性的评分,有着复杂性、主观性和低灵敏度的缺点,临床工作中需要更为简单、快捷、敏感的AP评价指标来早期评估病情和预测预后。血清抵抗素(resistin)是一种脂肪因子,近年来已有许多国内外学者研究其对AP严重程度预测的作用,却得出了不同的答案。我们对这一问题进行meta分析,以扩大研究的总样本量,以探索血清抵抗素在AP发生发展中的变化,以及其对AP的严重程度是否有预警作用。方法:根据研究主题制定的检索策略,由研究员根据已制定的纳入、排除及质量评价标准于维普、万方、CNKI、CBM、Cochrane、Pubmed、SCI、embase数据库中搜索相关文献进行初筛,通过进一步的复筛来筛选及评价相关文献,队列研究、病例对照研究均采用NOS评价标准在筛选与评价。过程中,若有分歧或其他问题,则通过和第三方讨论解决。按照PICO的原则设计资料提取表格,并提取数据。我们采用stata16.0进行统计学分析。结果:1.共纳入10篇文献,其中6例病例对照研究、4例队列研究,5篇英文、5篇中文,涉及国内外5个国家(5篇中国、2篇土耳其、1篇美国、1篇立陶宛、1篇印度)2洲(亚洲、欧洲),均为观察性研究,共1116例样本量,研究结果分为三部分设计:第一部分为MAP患者血清抵抗素水平与健康人群进行组间比较;第二部分是根据血清抵抗素的监测时间分组,分别比较实验组和对照组中入院后第1、3、7天时的血清抵抗素水平;第三部分是各组间按病程发展进行血清抵抗素水平变化的组内比较。2.Meta分析结果:MAP患者血清抵抗素水平高于健康对照组;SAP患者血清抵抗素水平高于MAP组;病程前3天,AP患者中血清抵抗素水平呈上升,发展至临床缓解期,抵抗素水平下降。结果数据异质性较显著,我们又根据研究类型、研究质量、研究语言、研究地区分为4个亚组进一步探讨异质性来源。最后进行敏感性分析及egger检验均提示该结果较为稳定可靠,无明显的发表偏倚。结论:血清抵抗素水平变化与AP患者病情变化密切相关,在MAP的早期即可有升高,显著高于健康人水平;SAP患者中血清抵抗素水平显著高于MAP患者;且随着疾病的进展,血清抵抗素的水平在AP患者中均会升高,而随着疾病的恢复,血清抵抗素水平会逐渐下降。更多还原

【Abstract】 Objective:Acute pancreatitis,(Acute pancreatitis,AP)is clinically common Acute abdominal disease,a common cause with hyperlipidemia,gallstone,viral and autoimmune etc.,due to the abnormal activation of pancreatic enzymes the pancreas produce digestive function itself and the surrounding organs and cause,common clinical manifestation of abdominal pain that does not relieve,with nausea,vomiting,etc.The local inflammatory reaction of the pancreas itself is the main,which can be self-limited in mild cases,and can lead to multiple organ dysfunction and endanger life when it develops to the critical degree.The disease has a high incidence both at home and abroad,bringing huge economic losses,physical and mental pain to patients,and even causing death.Therefore,it is very important to assess the disease early,predict the prognosis of the disease and timely take corresponding intervention measures.The existing criteria for disease assessment,such as some comprehensive scores,have disadvantages of complexity,subjectivity and low sensitivity.Therefore,more simple,fast and sensitive AP evaluation indicators are needed in clinical work to assess the disease and predict the prognosis at an early stage.In recent years,many scholars at home and abroad have studied the role of serum resistin in predicting the severity of AP,but they have obtained different answers.We conducted a meta-analysis on this issue to expand the total sample size of the study to explore the changes in serum resistin in the development of AP and whether it has a predictive effect on the severity of AP.Methods:According to the retrieval strategy formulated by the research subject,the researchers searched relevant literatures in The VIP,Wanfang,CNKI,CBM,Cochrane,Pubmed,SCI and EMbase databases for preliminary screening and further screening and evaluation of relevant literatures.Cohort studies and casecontrol studies were screened and evaluated by NOS evaluation criteria.During the process,if there is any disagreement or other problem,it shall be solved through discussion with the third party.According to the principles of PICO,the data extraction form was designed and the data was extracted.Stata16.0 was used for statistical analysis.Results:1.Participants included 10 articles,including 6 cases of case-control study,4cases of cohort study,5,5 Chinese article in English,at home and abroad involving five countries(5,2 Chinese article 1 piece of the United States,Turkey,Lithuania,1 piece of India)2 continents(Asia,Europe),are based on observational studies,a total of 1116 cases of sample size,the results of the study design is divided into three parts: In the first part,the serum resistin level of MAP patients was compared with that of healthy people.The second part was divided into groups according to the monitoring time of serum resistin,and the serum resistin levels of the experimental group and the control group were compared on the first,third and seventh days after admission.The third part is the intra-group comparison of the changes of serum resistin levels according to the course of disease.2.Meta-analysis results: MAP patients had higher serum resistin levels than healthy controls;The level of resistin in SAP patients was higher than that in MAP group.During the first 3 days of the disease course,serum resistin levels increased in AP patients and decreased when they progressed to clinical remission.Results Data heterogeneity was significant,and we divided the data into 4 subgroups according to the study type,study quality,study language and study region to further explore the source of heterogeneity.Sensitivity analysis and egger test indicated that the results were stable and reliable,without obvious publication bias.Conclusion:The level of serum resistin was closely related to the changes of AP patients,and increased at the early stage of MAP,which was significantly higher than that of healthy people.The level of serum resistin in SAP patients was significantly higher than that in MAP patients.With the progression of the disease,the level of serum resistin in AP patients will increase,and with the recovery of the disease,the level of serum resistin will gradually decrease.更多还原