婴幼儿皮纹不对称对发育性髋关节发育不良的阳性预测价值系统评价和meta分析.docx

婴幼儿皮纹不对称对发育性髓关节发育不良的阳性 预测价值：系统评价和meta分析李贤枫，张天久*,杨小红，徐艳朋，吕欣 贵州省儿童医院，遵义医科大学附属医院小儿外科 *通讯作者：张天久【摘要】目的：通过系统性评价和Meta分析评估婴幼儿皮纹不对称 (Asymmetric Skinfolds, ASF)是否对发育性骸关节发育不良(Developmental Dysplasiaofthe Hip, DDH)有阳性预测价值，探讨婴幼儿ASF作为DDH 早期筛查体征的必要性。方法：通过系统文献检索建库至2022年7月 1 日 PubMed> Embase> Web of Science> Cochrane> 维普、中国 知网、 万方数据库及中国生物医学文献数据库关于ASF与DDH的相关研究。 纳入研究包括：(I)具有腹股沟、大腿或臀部ASF行骸关节超声筛查的婴 幼儿为ASF组；(II)无任何阳性体征进行靓关节超声筛查的婴幼儿为阴 性体征对照组；(In)具有双下肢不等长、Ortolani征、Barlow征或髓关 节外展受限等阳性体征进行酸关节超声筛查的婴幼儿为阳性体征对照 组；(IV)能够提供有效的数据信息。应用StataI5.1软件进行Meta分析 和敏感性分析，并制作森林图和漏斗图，比较婴幼儿ASF组和阴性体征 对照组、阳性体征对照组对DDH的阳性预测价值。结果：共16项研究 符合纳入标准，共计49795例婴幼儿；和阴性体征对照组24266例，诊 断DDH为276例进行比较，ASF组为5593例，诊断DDH为296例， Meta分析结果显示，ASF组中DDH的发生率高于阴性对照组(RR=I.029, 95%CI: 1.003-1.055) , p=0.028;和阳性体征对照组 1777 例，诊断 DDH 为302例进行比较，ASF组为20916例，诊断DDH为370例，Meta分 析结果显示，ASF组中DDH的发生率明显低于阳性体征对照组(RR=0.90, 95%CI: 0.85-0.95) , p=0.000o 结论：婴幼儿 ASF 对 DDH 有一定的阳性预测价值，是发生DDH的危险因素之一，但危险程度较 双下肢不等长、Ortolani征、BarloW征或骸关节外展受限等阳性体征低。【关键词】皮纹不对称；发育性髓关节发育不良；预测价值；队列研 究；Meta分析The positive predictive value of asymmetrical skinfolds in the diagnosis of developmental dysplasia of the hip with infants: a systematic review and Meta analysisLI XianFeng9ZHANG TianJiu*,YANG XiaoHong9XU YanPeng9LV XinDepartment of Pediatric Surgery, Affiliated Hospital of Zunyi MedicalUniversity,Guizhou Children1S Hospital* Corresponding author: ZHANG TianjiuAbstract Objective To evaluate whether ASF has a positive predictive value for DDH through systematic review and meta-analysis, and to explore the necessity of ASF as an early screening sign for DDH in infants. Methods The database was established through systematic search until July 1, 2022 for related research on ASF and DDH in PubMed, Embase, Web of Science, Cochrane, VIP, CNKI, Wanfang Database and China Biomedical Literature Database. Included studies included: (I) Infants with groin, thigh, or buttocks ASF for hip ultrasound screening as ASF group; (II) Infants without any positive signs for hip ultrasound screening as control group of negative sign; ( III) Infants with positive signs such as unequal length of lower extremities, Ortolani1S sign, Barlow,s sign or limited hip abduction as control group of positive signs; (IV) Had valid data information. Statal5.1 software was used for Meta analysis, and forest plot and funnel plot were made to compare the positive predictive value of DDH in ASF group, control group of negative sign and control group of positive sign. Results 16 studies met the inclusion criteria with a total of 49795 infants; 5593 cases in ASF group and 296 cases diagnosed with DDH, compared with 24266 cases in control group of negative sign and 276 cases diagnosed with DDH, the results of Meta-analysis showed that the incidence of DDH in ASF group was higher than that in control group of negative sign (RR=1.029, 95%CI: 1.003-1.055), p=0.028. 20916 cases in ASF group and 370 cases diagnosed with DDH, compared with 1777 cases in control group of positive sign and 302 casesdiagnosed with DDH, the results of Meta-analysis showed that the incidence of DDH in ASF group was significantly lower than that in control group of positive sign (RR=0.90, 95%CI: 0.85-0.95), p=0.000. Conclusion: ASF in infants has a certain positive predictive value for DDH, and it is one of the risk factors for DDH, but the risk is lower than that of positive signs such as unequal length of lower limbs, Ortolani,s sign, Barlow,s sign or limited hip abduction.Keywords asymmetric skinfolds; developmental dysplasia of the hip; predictive value; cohort study; meta-analysis发育性酸关节发育不良(DDH)是儿童常见的发育畸形之一，治疗方式及治 疗效果与治疗时的年龄密切有关，越早发现，方法越简单，效果越好，并发症越 少山。在发达国家，为了提高早期诊断率，已进行了广泛的婴幼儿DDH 筛查，目前超声检查和Graf分型被认为是诊断婴幼儿DDH的金标准。 我国尚未普及大范围的婴幼儿DDH超声筛查，所以需要我们专科医生对具有 DDH危险因素的婴幼儿进行早期识别和检查，不仅可减少医疗资源的浪费，还 可提高DDH的诊断率。DDH在不同年龄段的临床表现差异较大，对行走期的儿童来说，跛行步态 或摇摆步态等异常步态易于被发现。在婴幼儿期的表现不够明显，有臀位产、羊 水过少和阳性家族史是发生DDH的高危因素，具有双下肢不等长、Ortolani征 或Barlow征阳性和酸关节外展受限等阳性体征的婴幼儿发生DDH的危险性也 较大叫但经常被父母发现而就诊，或者被保健医生和儿科医生转诊的 常见婴幼儿ASF4,5,且在许多国家和地区被推荐作为婴幼儿DDH筛查 的一个重要阳性体征，是否明确对DDH有阳性预测价值仍有争议， ASF和DDH之间有无相关性，ASF是否为DDH的危险因素仍需要进 一步研究。皮纹不对称ASF是婴幼儿在是小儿外科门诊就诊和儿科医生转诊 进行发育性酸关节发育不良DDH筛查的主要体征之一，究竟婴幼儿 ASF对DDH有无阳性预测价值，是否为DDH的危险因素，两者之间有 无相关性，目前争议较大，也无较高水平的科学证据。本文对近年来婴 幼儿ASF进行DDH筛查的相关临床研究进行系统性评价，并通过Meta 分析，旨在明确婴幼儿ASF对DDH有无阳性预测价值，是否为DDH 的危险因素，为今后婴幼儿DDH的早期临床筛查提供更多的循证医学 证据。资料与方法一、文献收集与检索计算机检索 PUbMed、Embase> Web of Science> Cochrane> 维 普、中国知网、万方及中国生物医学文献数据库。检索时间均为建库 至2022年7月1日。中文检索词为：皮纹不对称、臀纹不对称、腹股 沟纹不对称、腿纹不对称、发育性髓关节发育不良、发育性酸关节脱 位、先天性酸关节脱位、酸臼发育不良。英文检索词为：developmental dislocation of the hip, developmental dysplasia of the hip、asymmetric skin, asymmetric skinfolds, asymmetrical skin creaseso 通过手工方式进一步 检索纳入文献的参考文献。二、纳入与排除标准1、纳入标准：（1）研究类型为前瞻性队列研究或回顾性队列研 究，语种限于英文和中文。（2）研究对象均为0-12月婴幼儿。（3） 暴露因素：皮纹不对称，包括腹股沟皮纹不对称、大腿皮纹不对称和 臀部皮纹不对称。（4）对照组：分为无任何阳性体征的阴性体征对照 组；和表现为双下肢不等长、OrtOIani或BarlOW征、酸关节外展受限 等阳性体征的阳性体征对照组。（5）结局指标：根据Graf分级标准 诊断DDHo2.排除标准：（1）在筛查前已经明确诊断为DDH的婴幼儿；具 有系统性疾病或遗传性疾病的婴幼儿。（2）无对照组，不能提取有效 数据信息，没有全文文章的摘要、未公开发表的毕业论文、笔记、信 件、会议文章等。（3