中国大陆中小学生脊柱侧凸的患病特点：关于72项研究的Meta分析

The prevalence and characteristics of primary and middle-school students in China: a Meta-analysis based on 72 epidemiological research

中文关键词:  脊柱侧凸  中小学生  中国大陆  流行病学调查  Meta分析

英文关键词:Scoliosis  Students of primary and middle school  Mainland China  Epidemiological research  Meta analysis

中文摘要:

  【摘要】 目的：基于流行病学调查进行Meta分析，明确中国大陆中小学生脊柱侧凸的患病率和时间-空间分布特征。方法：检索数据库为PubMed、Scopus、万方数据库、中国知网、国家科技图书文献中心及维普网，检索时间为1980年1月～2020年12月。纳入文献为中小学生脊柱侧凸筛查相关横断面研究，诊断方法涉及初筛、二筛或三筛的物理检查、躯干旋转角测量、云纹图和X线检查等，两名人员独立提取数据（包括文献作者和发表年份、地区、筛查人数、初筛、二筛、三筛的阳性人数和侧凸类型等）并进行文献质量评价。本研究依据文献时间（2000年前后）和调查地区（东、中、西部）进行亚组分析；整体Meta分析和亚组分析结果用比值比（odds ratios，ORs）和95%可信区间（confidential interval，CI）表示。研究主要结果为侧凸初筛阳性率和确诊率，此外该研究还拟探讨患病率与地理因素的相关性。结果：研究共纳入72篇文献涉及28省共2493217名研究对象。整体初筛和二筛阳性率分别为（4.40±2.81）%和（2.18±1.68）%，确诊率平均为（1.23±1.06）%，特发性脊柱侧凸（idiopathic scoliosis，IS）平均患病率为（1.16±0.94）%。Meta分析提示初筛和三筛女性阳性率均高于男性（OR=1.36，95%CI=1.14-1.62和OR=1.57，95%CI=1.37-1.80）。不论研究在2000年前后以及不论在东、中、西部开展筛查，亚组分析结果均与整体一致。轻度侧凸者占79.5%，IS在东部地区患病率低于中部地区（P=0.030）。患病率与年份和地理因素（经济发达程度、纬度、海拔）均无明确线性相关性，但患病率在2008年后存在逐年上升趋势。结论：中国大陆脊柱侧凸患病率为1.23%且女性为男性的1.57倍；患病率自2008年后存在逐年上升趋势。

英文摘要:

  【Abstract】 Objectives: A Meta-analysis was performed based on epidemiological studies, to identify the prevalence of scoliosis as well as the spatio-temporal characteristics in primary and middle-school students in China. Methods: The databases of PubMed, Scopus, WanFang, CNKI, NSTL and WeiPu were screened on scoliosis from January, 1980 to December, 2020. The included studies were cross-sectional research on scoliosis of children and adolescent. The diagnosis of scoliosis based on general examination, angle of trunk rotation, moire photograph or radiography. Data extraction and quality assessment were performed by two independent reviewers, included the author and publication year, region, screening number, positive number of primary screening, second screening and third screening, and scoliosis type. Apart from overall Meta-analysis, the subgroup analysis were respectively performed in terms of study period(before and after 2000 year) and study regions(Western, Middle and Eastern Region). The analysis was to calculate odds ratios(ORs) and 95% confidential interval(CI). The prevalence of primary and final screening of scoliosis was the main outcomes. Then, the correlation between prevalence and geographical factors was also analyzed. Results: A total of 72 studies referring to 28 provinces with 2493217 participants were eligible. The mean positive rate of primary and secondary screening was (4.40±2.81)% and (2.18±1.68)%. The prevalence was (1.23±1.06)% and the prevalence of idiopathic scoliosis(IS) was (1.16±0.94)%. The positive rate by primary and final screening both showed higher in girls than boys(OR=1.36, 95%CI=1.14-1.62 and OR=1.57, 95%CI=1.37-1.80, respectively). The outcomes in subgroup analysis was in consistence with the overall analysis no matter the study period or study regions. The proportion of mild severity was 79.5%, and the prevalence of IS was lower in Eastern- than Middle-Region(P=0.030). There was not identified linear correlation between the prevalence and socio-demographic index, altitude and latitude, while the prevalence showed an increasing trend since 2008. Conclusions: The prevalence of scoliosis in primary and middle-school students in China was 1.23% and 1.57-times higher in girls. The prevalence showed an increasing trend since 2008.