中国人腰椎间盘突出后重吸收发生率的Meta分析

目的:分析中国人腰椎间盘突出后重吸收的发生率。方法:计算机检索中国知网、万方数据库、维普网2010年1月至2020年5月收录的所有有关中国人腰椎间盘突出后突出的椎间盘组织体积变化的中文文献,并手工检索相关文献。筛选文献后提取随访患者总数、发生重吸收患者数量、研究类型、重吸收判断方法(定性判断或定量判断)等重要数据,使用随机效应模型进行Meta分析,并进行亚组分析、敏感性分析、Meta回归分析和发表偏倚分析。结果:共检索到2301篇文献,最终纳入20篇文献进行分析。20项研究共随访1214例患者,723例发生重吸收;其中随机对照试验5项,前瞻性非随机对照试验11项,回顾性研究4项;7项研究采用定量方法判断重吸收情况,13项研究采用定性方法判断重吸收情况。Meta分析结果显示,腰椎间盘突出后重吸收的发生率为54%I~2=98%,P=0.000;95%CI(0.36,0.72)]。亚组分析显示,随机对照试验、前瞻性非随机对照试验、回顾性研究的重吸收发生率比较,差异无统计学意义(Q=0.30,P=0.86);采用定量和定性方法判断重吸收情况的研究,重吸收发生率比较,差异无统计学意义(Q=0.14,P=0.70)。通过逐个剔除纳入的研究进行敏感性分析,结果显示腰椎间盘突出后重吸收发生率在50%95%CI(0.33,0.67)]至58%95%CI(0.41,0.75)]之间,提示Meta分析结果稳定。Meta回归分析显示,研究类型(R~2=0,P=0.820)和采用不同方法判断重吸收(R~2=15.34%,P=0.740)均不是异质性来源。Egger’s test未检测到发表偏倚存在(P=0.130)。结论:中国人腰椎间盘突出后重吸收的发生率为54%,临床上在选择手术治疗前应充分考虑腰椎间盘突出后重吸收的可能性。

Incidence of spontaneous resorption of lumbar disc herniation in Chinese:a meta analysis

Objective:To analyze the incidence of spontaneous resorption of lumbar disc herniation(LDH)in Chinese.Methods:All the Chinese articles about volume change of protrusion in Chinese LDH patients included from January 2010 to May 2020 were retrieved from China national knowledge internet,WanFang Database and VIP Database through computer.Meanwhile,all the relevant articles were manual retrieved.The information about total number of patients with follow-up,number of patients with spontaneous resorption of LDH,research type and qualitative and quantitative judgment method of spontaneous resorption were extracted from the articles,and Meta-analysis including subgroup analysis,sensitivity analysis,Meta regression analysis and publication bias analysis were conducted by using random effect model(REM).Results:Two thousand three hundred and one articles were searched out.After screening,20 articles(1214 patients with follow-up and 723 patients with spontaneous resorption of LDH)were included in the final analysis,including 5 randomized controlled trial(RCT)articles,11 prospective non-RCT articles and 4 retrospective trial articles.The spontaneous resorption was judged by quantitative method in 7 articles and qualitative method in 13 articles.The results of Meta-analysis demonstrated that the incidence rate of spontaneous resorption of LDH was 54%(I 2=98%,P=0.000;95%CI(0.36,0.72)).The results of subgroup analysis demonstrated that there was no statistical difference in the incidence rate of spontaneous resorption between RCT,prospective non-RCT and retrospective trial(Q=0.30,P=0.86)and between quantitative study and qualitative study(Q=0.14,P=0.70).The sensitivity analysis was performed through excluding the included articles in turn,and the results showed that the incidence rate of spontaneous resorption of LDH was between 50%(95%CI(0.33,0.67))and 58%(95%CI(0.41,0.75)),which suggested that the results of Meta analysis were stable.The results of Meta regression analysis demonstrated that both research type(R 2=0,P=0.820)and judgment method(R 2=15.34%,P=0.740)of spontaneous resorption were not the sources of heterogeneity.No publication bias was found by Egger’s test(P=0.130).Conclusion:The incidence rate of spontaneous resorption of LDH is 54%in Chinese.The possibility of spontaneous resorption of LDH should be fully considered before the surgical treatment in clinic.