出生体重与慢性肾脏病关联性的系统评价和Meta分析

目的系统评价出生体重与慢性肾脏病风险的关联性。方法电子检索The Cochrane图书馆、MEDLINE、OVID数据库、Springer数据库、维普数据库、万方数据库和中国知网,检索时间为建库截止至2016年6月,纳入以BW为暴露因素、评估生后发生CKD或其相关结局变量的观察性研究,文献需对CKD或其他结局变量的诊断标准做出描述并能提取CKD或其相关结局变量的OR值及其95%CI,语种限定为中、英文;排除文献:研究对象生后12个月内肾功能衰竭和死亡、有宫内感染病史或患先天遗传性疾病,母孕期暴露因素有潜在毒性物质接触史,研究人群包括成人和儿童但无法单独提取儿童数据。由两位作者独立检索关于出生体重(BW)对CKD风险相关的观察性研究,病例对照和队列研究采用NOS量表、横断面研究采用AHRQ量表对文献进行偏倚风险评价,提取OR值和95%CI。应用Stata 12.0对文献进行Meta分析,均选用Der SimonianLaird随机效应模型分析。结果 10篇观察性研究纳入本文分析,其中病例对照4篇(3篇8分,1篇7分),队列研究4篇(3篇7分,1篇8分),横断面研究2篇(1篇7分,1篇8分)。慢性肾脏病风险低出生体重(LBW)较正常BW人群高约80%,OR=1.80,95%CI:1.37~2.35;其中蛋白尿、终末期肾脏病和低e GFR在LBW较正常BW人群的OR及其95%CI分别为2.58(1.49~4.46)、1.42(1.22~1.66)和1.87(1.19~2.94)。终末期肾脏病、低e GFR在高出生体重(HBW)中较正常BW人群的OR及其95%CI分别为1.19(0.94~1.49)和1.09(0.93~1.27),HBW与生后慢性肾脏病之间无明显关联;LBW人群作为慢性肾脏病的高危人群仅见于男性人群中,OR=1.83,95%CI:1.10~3.05)。Egger回归提示纳入文献不存在发表偏倚。结论男性LBW是CKD的高危因素,HBW与生后CKD的发生无明显关联。

The relationship between birth weight and chronic kidney disease:a systematic review and meta-analysis

Objective To systematically review the association between birth weight with risk of the chronic kidney disease.Methods The Cochrane Library,MEDLINE,OVID,Springer,VIP,WangFang Data and CNKI up to June 30,2016 were searched to retrieve the online observation studies about birth weight and chronic kidney disease and other relative outcomes.The articles were selected if they were published in English or Chinese regarding the association between birth weight and CKD,which included the exact information on OR and 95%CI.Excluded studies: Studies that assessed the final outcome among neonates or children less than 1 year old,the participants of studies who were infected in utero,congenital abnormalities,the mothers who were exposed to toxins,as well as the incompletely information literature.Two reviewers inspected the included studies on the association between birth weight and chronic kidney disease independently.Quality assessment was performed based on the Newcastle Ottawa Scale(case-control study and cohort study)and AHRQ(cross-sectional study).OR and 95％CI were extracted from the selected articles and then analyzed with Stata 12.0 software by the way of DerSimonian & Laird.Results Ten observational studies containing four case-control studies(three articles in 8 points and one article in 7 points),four cohort studies(three articles in 7 points and one article in 8 points)and two cross-sectional studies(7 points and 8 points for the two articles)were selected finally.The overall combination of weighted estimates from the selected 10 studies about low birth weight associated with risk of the chronic kidney disease was 1.80(1.37-2.35).The risks of albuminuria(OR,2.58;95％CI,1.49-4.46),end-stage renal disease(OR,1.42;95％CI,1.22-1.66),or lower estimated glomerular filtration rate(OR,1.87;95％CI,1.19-2.94)were similar with the chronic kidney disease.However,according to the subgroup analysis that the combined OR of high birth weight between end-stage renal disease and lower estimated glomerular filtration rate was OR,1.19;95％CI,0.94-1.49 and OR,0.09;95％CI,0.93-1.27,which showed no significant impact.In the subgroup analysis by gender,increased risk was only found in men:1.83(1.10-3.05),unexpectedly.Finally,the Egger regression method showed no publication bias.Conclusion Only men with low birth weight had a greater CKD risk in later life.And the high birth weight did not show any significant impact on CKD.