圆锥角膜的危险因素：系统综述与荟萃分析。
完整摘要 · 中文译文
目的：圆锥角膜（KC）是一种威胁视力的疾病，其病因尚不明确。了解其危险因素对于预防和机制研究至关重要。本研究通过全面的系统综述和荟萃分析，评估与圆锥角膜相关的因素，并综合现有证据。 方法：在PubMed、Cochrane图书馆、Embase和Web of Science中进行了全面的文献检索，检索报告与圆锥角膜相关因素的研究，不限制发表日期或语言，检索时间从建库至2025年9月。计算合并比值比（OR）及其95%置信区间（CI）。至少两名作者使用乔安娜布里格斯研究所（JBI）的评估工具对最终纳入研究的方法学质量进行评价。按地区和年龄进行亚组分析以减少研究间的异质性。采用定量统计检验（Egger检验和Begg检验）及定性漏斗图全面评估发表偏倚的存在。 结果：我们共纳入33项研究，涉及1,537,739名个体：其中21项为病例对照研究，4项为队列研究，8项为横断面研究。本分析纳入的14个因素及其OR（95% CI）如下：家族史 8.95（5.24，15.28），揉眼 6.20（4.32，8.91），过敏 1.68（1.25，2.26），特应性体质 1.39（0.90，2.15），眼部过敏 6.40（2.44，16.73），过敏性皮炎/湿疹 1.99（1.34，2.96），哮喘 1.63（1.38，1.93），过敏性鼻炎 1.37（1.12，1.67），不当睡姿 5.55（1.3 5，22.76），干眼病2.55（1.05，6.18），肥胖1.40（1.03，1.88），吸烟0.80（0.65，0.99），炎症性肠病1.24（0.95，1.63），糖尿病0.87（0.69，1.10）。 结论：阳性家族史、揉眼、过敏、过敏性皮炎/湿疹、哮喘、过敏性鼻炎、不当睡姿、干眼病和肥胖与圆锥角膜可能性增加显著相关，而吸烟表现出保护作用。未发现KC与特应性体质、炎症性肠病或糖尿病之间存在显著关联。需要对这些因素采用标准化定义和严重程度分级，以阐明因果机制并为循证预防策略提供依据。
完整摘要 · 英文原文
PURPOSE: Keratoconus (KC) is a sight-threatening disease with unclear etiology. Understanding its risk factors is essential for prevention and mechanistic insight. This study presents a comprehensive systematic review and meta-analysis to evaluate the factors associated with keratoconus, synthesizing the available evidence. METHODS: A comprehensive literature search was performed in PubMed, the Cochrane Library, Embase, and Web of Science for studies reporting factors associated with keratoconus, with no restrictions on publication date or language, from inception to September 2025. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. At least two authors used the assessment tools of the Joanna Briggs Institute (JBI) to evaluate the quality of the methodology of the final included studies. Subgroup analysis by region and age was conducted to reduce the heterogeneity among studies. Both quantitative statistical tests (Egger's and Begg's tests) and qualitative funnel plots were employed to comprehensively evaluate the existence of publication bias. RESULTS: We identified 33 studies involving 1,537,739 individuals: 21 were case-control studies, 4 were cohort studies, and 8 were cross-sectional. 14 factors included in this analysis and their OR (95% CI) are as follows: family history 8.95(5.24, 15.28), eye rubbing 6.20(4.32, 8.91), allergy 1.68(1.25, 2.26), atopy 1.39(0.90, 2.15), eye allergy 6.40(2.44, 16.73), allergic dermatitis/eczema 1.99(1.34, 2.96), asthma 1.63(1.38, 1.93), allergic rhinitis 1.37(1.12, 1.67), inappropriate sleeping position 5.55(1.35, 22.76), dry eye disease 2.55(1.05, 6.18), obesity 1.40(1.03, 1.88), smoking 0.80(0.65, 0.99), inflammatory bowel disease 1.24(0.95, 1.63), diabetes 0.87(0.69, 1.10). CONCLUSION: Positive family history, eye rubbing, allergy, allergic dermatitis/eczema, asthma, allergic rhinitis, inappropriate sleeping positions, dry eye disease, and obesity are significantly associated with an increased likelihood of keratoconus, whereas smoking exhibited a protective effect. No significant associations were found between KC and atopy, inflammatory bowel disease, or diabetes. Standardized definitions and severity gradings of these factors are needed to clarify causal mechanisms and inform evidence-based preventive strategies.