目的：探讨坏疽性胆囊炎的危险因素，为该病的早期诊断和治疗提供循证医学依据。方法：系统性检索Pubmed、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据数据库中有关坏疽性胆囊炎危险因素的队列研究和病例对照研究，检索时限为建库至2023年6月。采用Review Manager 5.3软件对所提取的数据进行统计分析。结果：共纳入14篇文献，共涉及11个危险因素，总样本量为4 207。Meta分析结果显示全身炎症反应[OR=23.99,95%CI(12.46,46.19)]、合并冠心病[OR=21.50,95%CI(6.08,76.06)]、胆囊壁增厚[OR=17.31,95%CI(8.64,34.70)]、发热[OR=8.64,95%CI(4.60,16.21)]、年龄[OR=7.89,95%CI(6.99,8.78)]、白细胞计数[OR=5.73,95%CI(5.45,6.02)]、合并糖尿病[OR=5.35,95%CI(4.10,6.98)]、总胆红素[OR=3.73,95%CI(2.33,5.99)]、谷丙转氨酶[OR=2.96,95%CI(1.96,4.48)]、男性[OR=2.52,95%CI(2.00,3.17)]是发生坏疽性胆囊炎的危险因素(P＜0.05),合并胆囊结石[OR=0.12,95%CI(0.07,0.23)]是发生坏疽性胆囊炎的保护因素(P＜0.05)。结论：高龄男性，合并糖尿病、冠心病，出现发热、白细胞升高等全身炎症反应，合并谷丙转氨酶、总胆红素升高，超声检查显示胆囊壁增厚为坏疽性胆囊炎的危险因素。 |
Objective: To explore the risk factors of gangrenous cholecystitis, and to provide evidence-based medical evidence for early diagnosis and improvement of prognosis. Methods: Database of Pubmed, Embase, Cochrane Library, Web of Science, CNKI, CBM and Wanfang Data were searched. To search for cohort and case-control studies on risk factors for gangrenous cholecystitis, the search period was from established until June 2023. Review Manager 5.3 software was used for statistical analysis of the extracted data. Results: A total of 14 articles were included, involving a total of 11 risk factors, with a total sample size of 4 207. Meta analysis results showed systemic inflammatory reaction [OR=23.99,95%CI(12.46,46.19)],complicated coronary heart disease [OR=21.50,95%CI(6.08,76.06)], gallbladder wall thickening [OR=17.31,95%CI(8.64,34.70)], fever [OR=8.64,95%CI(4.60,16.21)], age [OR=7.89,95%CI(6.99,8.78)], white blood cell count [OR=5.73,95%CI(5.45,6.02)], complicated diabetes [OR=5.35,95%CI (4.10,6.98)], total bilirubin [OR=3.73,95%CI(2.33,5.99)], glutamic transaminase [OR=2.96,95%CI(1.96,4.48)] and male [OR=2.52,95%CI(2.00,3.17)] were risk factors for the occurrence of gangrenous cholecystitis(P<0.05), while the presence of gallbladder stones [OR=0.12,95%CI(0.07,0.23)] was a protective factor for the occurrence of gangrenous cholecystitis(P<0.05). Conclusion: Elderly men, diabetes, coronary heart disease, fever, elevated white blood cells and other systemic inflammatory reactions, combined with elevated alanine aminotransferase, ultrasonography showed that gallbladder wall thickening are risk factors for gangrene cholecystitis. |
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