炎症性肠病中血小板参数的异常：系统评价和荟萃分析。

BACKGROUND: Platelet dysfunction plays a critical role in the pathogenesis of inflammatory bowel disease (IBD). Despite clinical observations indicating abnormalities in platelet parameters among IBD patients, inconsistencies persist, and these parameters lack standardization for diagnosis or clinical assessment. METHODS: A comprehensive search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases for relevant articles published up to December 16th, 2023. A random-effects model was employed to pool the weighted mean difference (WMD) and 95% confidence interval (95% CI) of platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) between IBD patients and healthy controls, and subgroup analyses were performed. RESULTS: The meta-analysis included 79 articles with 8,350 IBD patients and 13,181 healthy individuals. The results revealed significantly increased PLT and PCT levels (WMD: 69.910, 95% CI: 62.177, 77.643 10/L; WMD: 0.046%, 95% CI: 0.031%, 0.061%), and decreased MPV levels (WMD: -0.912, 95% CI: -1.086, -0.739 fL) in IBD patients compared to healthy individuals. No significant difference was found in PDW between the IBD and control groups (WMD: -0.207%, 95% CI: -0.655%, 0.241%). Subgroup analysis by disease type and disease activity showed no change in the differences for PLT, PCT, and MPV in the ulcerative colitis and Crohn's disease groups, as well as the active and inactive groups. Notably, the active group exhibited significantly lower PDW levels than the control group (WMD: -1.138%, 95% CI: -1.535%, -0.741%). CONCLUSIONS: Compared with healthy individuals, IBD patients display significantly higher PLT and PCT and significantly lower MPV. Monitoring the clinical manifestations of platelet abnormalities serves as a valuable means to obtain diagnostic and prognostic information. Conversely, proactive measures should be taken to prevent the consequences of platelet abnormalities in individuals with IBD. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023493848.

背景：血小板功能障碍在炎症性肠病（IBD）的发病机制中起着关键作用。尽管临床观察表明 IBD 患者的血小板参数存在异常，但这些参数仍然存在不一致，并且缺乏用于诊断或临床评估的标准化。

方法：我们对 PubMed、Embase、Web of Science 和 Cochrane Library 数据库进行了全面检索，以获取截至 2023 年 12 月 16 日发表的相关文章。采用随机效应模型对 IBD 患者与健康对照之间的血小板计数（PLT）、平均血小板体积（MPV）、血小板分布宽度（PDW）和血小板比容（PCT）的加权均数差（WMD）和 95%置信区间（95%CI）进行汇总，并进行了亚组分析。

结果：该荟萃分析纳入了 79 篇文章，共包含 8350 例 IBD 患者和 13181 名健康个体。结果显示，与健康对照相比，IBD 患者的 PLT 和 PCT 水平显著升高（WMD：69.910，95%CI：62.177，77.643 10/L；WMD：0.046%，95%CI：0.031%，0.061%），MPV 水平显著降低（WMD：-0.912，95%CI：-1.086，-0.739 fL）。IBD 组与对照组之间的 PDW 水平无显著差异（WMD：-0.207%，95%CI：-0.655%，0.241%）。按疾病类型和疾病活动度进行的亚组分析显示，溃疡性结肠炎和克罗恩病组以及活动期和非活动期组的 PLT、PCT 和 MPV 差异均无变化。值得注意的是，活动期组的 PDW 水平显著低于对照组（WMD：-1.138%，95%CI：-1.535%，-0.741%）。

结论：与健康个体相比，IBD 患者的 PLT 和 PCT 明显升高，MPV 明显降低。监测血小板异常的临床表现是获取诊断和预后信息的有价值手段。相反，应采取积极措施预防 IBD 个体血小板异常的后果。

系统评价注册：PROSPERO CRD42023493848。