非洲镰状细胞病患者的肝肾功能生化特征：病例对照研究的系统评价和荟萃分析。

Liver and renal biochemical profiles of people with sickle cell disease in Africa: a systematic review and meta-analysis of case-control studies.

机构信息

Department of Obstetrics and Gynaecology, Faculty of Medicine, Gulu University, P. O. Box 166, Gulu, Uganda.

Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.

出版信息

Syst Rev. 2024 Oct 15;13(1):260. doi: 10.1186/s13643-024-02662-6.

DOI:10.1186/s13643-024-02662-6

PMID:39407336

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11479572/

Abstract

BACKGROUND

Sickle cell disease (SCD) is a genetic blood disorder characterized by a painful vaso-occlusive crisis due to the sickling of red blood cells in capillaries. Complications often lead to liver and renal dysfunctions, contributing to morbidity and mortality, particularly for children under 5. This systematic review and meta-analysis aimed to evaluate the liver and renal functions of people with SCD (HbSS) compared to those without it (HbAA) in Africa.

METHODS

The protocol was registered with PROSPERO (CRD42022346771). We searched PubMed, Embase, Web of Science, and Google Scholar using the keywords "liver function", "renal function", "sickle cell disease", and "Africa" on 6th May 2023 for peer-reviewed articles with abstracts in English. We included case-control studies comparing SCD (HbSS) with controls without hemoglobinopathies (HbAA). We used the random-effect model to calculate the pooled average values for the blood tests of people with SCD in RStudio version 4.2.2.

RESULTS

Overall, 17 articles were analyzed from five African countries involving 1312 people with SCD and 1558 controls. The pooled mean difference of liver enzymes aspartate transaminase (AST) was 8.62 (95% CI - 2.99-20.23, I = 97.0%, p < 0.01), alanine transaminase (ALT) 7.82 (95% CI - 0.16-15.80, I = 99%, p < 0.01) and alkaline phosphatase (ALP) - 2.54 (95% CI - 64.72 - 59.64, I = 99%, p < 0.01) compared to controls. The pooled mean difference for the renal biochemical profiles creatinine - 3.15 (95% CI - 15.02; 8.72, I=99%, p < 0.01) with a funnel plot asymmetry of t = 1.09, df = 9, p = 0.3048 and sample estimates bias of 6.0409. The pooled mean difference for serum urea was - 0.57 (95% CI - 3.49; 2.36, I = 99%, p < 0.01), and the estimated glomerular filtration (eGFR) rate was 19.79 (95% CI 10.89-28.68 mL/min/1.73 m, I = 87%, p < 0.01) compared to controls.

CONCLUSION

People with SCD have slightly elevated liver enzymes and estimated glomerular filtration rates compared to controls in Africa. With all the heterogeneity (I) > 50%, there was substantial variation in the reported articles' results.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022346771.

摘要

背景

镰状细胞病（SCD）是一种遗传性血液疾病，其特征是由于红细胞在毛细血管中镰状化而导致疼痛的血管阻塞性危机。并发症常导致肝肾功能障碍，导致发病率和死亡率增加，尤其是 5 岁以下儿童。本系统评价和荟萃分析旨在评估非洲 SCD（HbSS）患者与无该病（HbAA）患者的肝功能和肾功能。

方法

该方案已在 PROSPERO（CRD42022346771）中注册。我们于 2023 年 5 月 6 日使用“肝功能”、“肾功能”、“镰状细胞病”和“非洲”等关键词在 PubMed、Embase、Web of Science 和 Google Scholar 上搜索了同行评议文献摘要。我们纳入了比较 SCD（HbSS）与无血红蛋白病对照（HbAA）的病例对照研究。我们使用 RStudio 版本 4.2.2 中的随机效应模型计算了 SCD 患者血液检测的汇总平均值。

结果

总体而言，我们从五个非洲国家的 17 篇文章中分析了涉及 1312 名 SCD 患者和 1558 名对照的研究。天冬氨酸转氨酶（AST）的汇总平均差异为 8.62（95%CI-2.99-20.23，I=97.0%，p<0.01），丙氨酸转氨酶（ALT）为 7.82（95%CI 0.16-15.80，I=99%，p<0.01），碱性磷酸酶（ALP）为-2.54（95%CI-64.72-59.64，I=99%，p<0.01）。与对照组相比，肾脏生化特征的肌酐为-3.15（95%CI-15.02；8.72，I=99%，p<0.01），漏斗图不对称性 t=1.09，df=9，p=0.3048，样本估计偏差为 6.0409。血清尿素的汇总平均差异为-0.57（95%CI-3.49；2.36，I=99%，p<0.01），估计肾小球滤过率（eGFR）为 19.79（95%CI 10.89-28.68 mL/min/1.73 m，I=87%，p<0.01）。