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中国循证儿科杂志

中国循证儿科杂志 ›› 2019, Vol. 14 ›› Issue (1): 58-63.

• 论著 • 上一篇    下一篇

儿童咯血病因分布的系统综述及率的Meta分析

李强1，2，4,况虹宇1，4,高娅3,吕铁伟1,易岂建1，2#br#   

  1. 1 重庆医科大学附属儿童医院心血管内科 重庆，400014；2 重庆儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验,重庆市儿童发育重大疾病诊治与预防国际科技合作基地 重庆，400014；3 重庆医科大学附属儿童医院呼吸内科 重庆，400014；4 共同第一作者
  • 收稿日期:2018-10-29 修回日期:2019-02-25 出版日期:2019-02-25 发布日期:2019-02-25
  • 通讯作者: 易岂建

Distribution of etiologies in pediatric hemoptysis: A systematic review and meta-analysis

LI Qiang1，2，4, KUANG Hong-yu1,4, GAO Ya3, LV Tie-wei1, YI Qi-jian1,2   

  1. 1 Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China; 2 Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China; 3 Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China; 4 Co-first author
  • Received:2018-10-29 Revised:2019-02-25 Online:2019-02-25 Published:2019-02-25
  • Contact: YI Qi-jian

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摘要： 目的了解引起儿童咯血的不同病因的分布率。 方法系统检索中文数据库(万方数据库、中国生物医学文献数据库、维普数据库和中国知网)及英文数据库(PubMed、Cochrane Library和Embase) 中描述儿童咯血病因分布的观察性研究，检索时间为建库至2018年1月1日，采用病例系列报告偏倚评价工具（CARE）对纳入文献进行质量评估，用Stata 14.1对各研究中重要病因的分布率进行Meta分析。 结果共筛选到文献11篇，纳入咯血患儿523例。传统数据分析显示，呼吸道感染（肺炎或支气管炎）为儿童咯血最重要的原因（36.4%），肺含铁血黄素沉着症（IPH）、肺结核和心肺血管异常分别占10.3%、5.0%和5.8%，支气管扩张症5.7%，支气管异物1.9%，外伤1.3%，其他病因10.4%，不明原因咯血占9.1%。 Meta分析显示，肺炎或支气管炎在国内外咯血患儿中的分布率为39.8%(95%CI：35.4%~44.1%)，IPH 8.3%（95%CI：4.6%~12.1%），肺结核4.5%(95%CI：2.5%~6.5%)，支气管扩张症4.9%(95%CI：2.7%~7.1%)，心肺血管异常为9.0%（95%CI：4.9%～13.2%）。国内儿童咯血的病因分布率与整体相比存在一定差异。 结论儿童咯血病因以感染性疾病、IPH和心肺血管异常最常见，其他疾病及不明原因咯血约占20%左右。

Abstract: ObjectiveTo provide the distribution of different etiologies in pediatric hemoptysis in China and abroad.MethodsChinese databases (Wanfang Data, CBM, VIP and CNKI) and English databases (PubMed, Cochrane Library and Embase) were searched for the retrospectively observational studies based on the criteria, which had been done by 2 independent reviewers up to January 1st, 2018. The quality of enrolled studies was assessed according to CARE checklist. The meta-analysis was performed by Stata 14.1.ResultsA total of 11 studies met the inclusion criteria, and a total of 523 children were involved. It was demonstrated that pneumonia and bronchitis were the most common causes(36.4%), and the other common causes included idiopathic pulmonary hemosiderosis (IPH, 10.3%), pulmonary tuberculosis (5.0%), cardiopulmonary vascular malformations (5.8%), bronchiectasis (5.7%), bronchial foreign bodies (1.9%), trauma (1.3%), other causes (10.4%) and unclear etiologies (9.1%). Outcomes in meta-analysis demonstrated that in total the prevalence rate of respiratory infection was 39.8% (95%CI: 35.4%-44.1%), and 8.3% (95%CI: 4.6%-12.1%) for IPH, 4.5% (95%CI: 2.5%-6.5%) for pulmonary tuberculosis, 4.9% (95%CI: 2.7%-7.1%) for bronchiectasis, and 9.0%(95%CI: 4.9%-13.2%) for cardiopulmonary vascular malformations. The distribution of etiologies was proved different in China.ConclusionThe causes leading to hemoptysis in children were different from those in adults, and the most common causes were infectious diseases, IPH and cardiopulmonary vascular malformations. Additionally, about 20% of pediatric hemoptysis was caused by other diseases and unclear conditions.