| Objective:To analyse the risk factors of Henoch-Schonlein purpura nephritis in children by Meta-analysis via systematically searching related literatures,this should help in the identification and prediction of Henoch-Schonlein purpura nephritis onset and progression and the intervention of the further development as soon as possible.Methods:PubMed,Embase,Cochrane Library,China Journal Full-text Database,China Biomedical Literature Database,VIP Database and Wanfang Database were systematically searched for eligible studies from January 1,2016 to October 31,2022.The English key words searched are:IgA Vasculitis,Henoch-Schonlein purpura,Nephritis,Kidney Diseases,Risk Factors and their free words.The Chinese key words searched are:Henoch-Schonlein purpura,nephritis,kidney damage,risk factors,related factors and their corresponding synonyms.Literatures of case-control study related to the risk factors of Henoch-Schonlein purpura nephritis were searched.The research subjects are children(age<=16 years old).The literatures include age,duration of rash,the times of rash recurrence,gastrointestinal bleeding,abdominal pain,streptococcal infection,obesity,plasma Fib,IgA,total cholesterol,triglycerides,platelets and other factors.According to the inclusion and exclusion criteria,the literatures that finally meet the requirements are managed by NoteExpress,and the quality of the literatures is evaluated by Newcastle-Walter Scale(NOS),so as to extract the relevant data that is finally included in the research or the data that can be converted to obtain the effect quantity.Meta-analysis was made on the counting and measurement data of this study through the Revman software version 5.4 provided by Cochrane website.The Odds ratio(OR)or mean difference(MD)and its corresponding 95%confidence interval(CI)were taken as the combined effect quantity,and the funnel chart of Revman software was used to evaluate the publication bias.Results:A total of 21 eligible literatures were identified after a thorough literature search,all of which were retrospective case-control studies(RCT).A total of 4,279 children diagnosed as Henoch-Schonlein purpura were studied,and they were divided into 1,651 cases of Henoch-Schonlein purpura nephritis group(HSPN group)and 2,628 cases of Henoch-Schonlein purpura group(HSP group)according to whether they were progressed to Henoch-Schonlein purpura nephritis.There was no obvious bias risk in the quality evaluation of 21 studies,and the scores of NOS scale were≥6.After analyzing the data,it is suggested that the risk factors related to Henoch-Schonlein purpura nephritis mainly include:age≥6 years old,duration of rash≥1 month,the times of rash recurrence>3 times,gastrointestinal bleeding,abdominal pain,streptococcal infection,obesity,elevated plasma Fib,IgA,total cholesterol,triglyceride and platelet.The results of the effects of every factor are as follows:1.Age≥6 years old,OR=3.25,95%CI(2.49,4.24),the number of children age≥6 years old in HSPN group was significantly higher than that in HSP group(Z=8.63,P<0.00001);2.The duration of rash ≥1 month,OR=3.92,95%CI(3.14,4.90),the number of children with duration of rash≤1 month in HSPN group was higher than that in HSP group,and the difference was statistically significant(Z=12.06,P<0.00001).3.The times of rash recurrence≥3 times,OR=2.98,95%CI(2.41,3.69),the number of children with the times of rash recurrence≥3 times in HSPN group was higher than that in HSP group,and the difference was statistically significant(Z=9.99,P<0.00001);4.Gastrointestinal bleeding:OR=3.13,95%CI(2.50,3.90).The number of children with gastrointestinal bleeding in HSPN group was higher than that in HSP group,and the difference was statistically significant(Z=10.07,P<0.00001).5.Abdominal pain,OR=2.78,95%CI(2.20,3.50).The incidence of abdominal pain in children with Henoch-Schonlein purpura nephritis(HSPN group)was higher than that in children with Henoch-Schonlein purpura(HSP group),and the difference was statistically significant(Z=8.62,P<0.00001).6.Streptococcus infection,OR=4.81,95%CI(2.27,10.19).The incidence of streptococcus infection in children with Henoch-Schonlein purpura nephritis(HSPN group)was higher than that in HSP group(Z=4.11,P<0.0001).7.Obesity:OR=3.09,95%CI(2.12,4.49).The number of obese children in Henoch-Schonlein purpura group(HSPN group)was higher than that in Henoch-Schonlein purpura group(HSP group),and the difference was statistically significant(Z=5.88,P<0.00001);8.Plasma Fib increased,MD=0.61,95%CI(0.47,0.75).Plasma Fib in children with Henoch-Schonlein purpura nephritis(HSPN group)was higher than that in children with Henoch-Schonlein purpura(HSP group),and the difference was statistically significant(Z=8.60,P<0.00001).9.IgA increased,MD=0.53,95%CI(0.44,0.62).The IgA of children with Henoch-Schonlein purpura nephritis(HSPN group)was higher than that of children with Henoch-Schonlein purpura(HSP group),and the difference was statistically significant(Z=11.71,P<0.00001).10.Total cholesterol(TC)increased,MD=0.88,95%CI(0.77,1.00).The TC of children with Henoch-Schonlein purpura nephritis(HSPN group)was higher than that of children with Henoch-Schonlein purpura(HSP group),and the difference was statistically significant(Z=14.69,P<0.00001).11.triglyceride(TG)increased,MD=0.53,95%CI(0.42,0.64).the TG of children with henoch-schonlein purpura nephritis(HSPN group)was higher than that of children with henoch-schonlein purpura(HSP group),and the difference was statistically significant(Z=9.52,p<0.00001).12.Platelet(PLT)increased,MD=77.95,95%CI(39.67,116.24).The PLT of children with Henoch-Schonlein purpura nephritis(HSPN group)was higher than that of children with Henoch-Schonlein purpura(HSP group),and the difference was statistically significant(Z=3.99,P<0.0001).Conclusion:The risk factors of Henoch-Schonlein purpura nephritis are age≥6 years old,duration of rash≥1 month,the times of rash recurrence≥3 times,gastrointestinal bleeding,abdominal pain,streptococcal infection,obesity,elevated plasma Fib,IgA,total cholesterol,triglyceride and platelet. |
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