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中国急性戊型肝炎重症化危险因素的Meta分析
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Abstract:
目的:评估中国戊型肝炎病毒感染与肝衰竭的关联,并探讨其重症化的临床特点及影响因素。方法:检索PubMed、Web of Science、Embase、中国知网(CNKI)、万方等数据库,筛选2012年至2023年间相关文献,通过纳排标准及用纽卡斯尔–渥太华量表进行文献的筛选及质量评价,并采用RevMan5.4软件进行Meta分析。结果:共纳入21项研究,包含5663例急性戊型肝炎患者,其中853例(15.06%)进展为重症。老年(OR = 2.62, 95% CI = 1.98~3.47)、男性(OR = 2.05, 95% CI = 1.06~3.98)、合并基础肝病即重叠感染(OR = 0.29, 95% CI = 0.21~0.42)、糖尿病(OR = 2.11, 95% CI = 1.42~3.11)的患者更易发生肝衰竭。重叠感染者中,重症化的主要危险因素按照其关联性由强到弱依次为:肝硬化(OR = 5.76, 95% CI = 3.61~9.19)、自身免疫性肝病(OR = 4.01, 95% CI = 1.35~11.92)、HBV感染(OR = 3.95, 95% CI = 2.21~7.04)、脂肪性肝病(OR = 1.13, 95% CI = 0.63~2.03)、酒精性肝病(OR = 1.07, 95% CI = 0.57~2.01)。结论:在中国,老年、男性、重叠感染以及糖尿病等是急性戊型肝炎重症化的主要影响因素。而伴有肝硬化的重叠感染者,重症化的风险显著增加。
Objective: To assess the association between Hepatitis E virus infection and hepatic failure in China, as well as to investigate the clinical characteristics and risk factors for severity. Methods: A systematic literature search was conducted across databases including PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wan Fang, focusing on studies published between 2012 and 2023. Studies were selected based on predefined inclusion and exclusion criteria, and the quality of the included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software. Results: A total of 21 studies involving 5663 patients with acute HEV infection, among which 853 cases (15.06%) progressed to severe hepatitis. Patients with elderly (OR = 2.62, 95% CI = 1.98~3.47), male (OR = 2.05, 95% CI = 1.06~3.98), underlying liver disease or co-infections (OR = 0.29, 95% CI = 0.21~0.42), and diabetes mellitus (OR = 2.11, 95% CI = 1.42~3.11), are at an increased risk of hepatic failure. For patients with co-infection, the main risk factors for severe progression, ranked from strongest to weakest association, were liver cirrhosis (OR = 5.76, 95% CI = 3.61~9.19), autoimmune liver disease (OR = 4.01, 95% CI = 1.35~11.92), HBV infection (OR = 3.95, 95% CI = 2.21~7.04), fatty liver disease (OR = 1.13, 95% CI = 0.63~2.03), and alcoholic liver disease (OR = 1.07, 95% CI = 0.57~2.01). Conclusion: In China, older age, male gender, superinfection, and diabetes mellitus
[1] | 中华人民共和国国家卫生康委员会. 2004-2019年全国法定传染病疫情概况[EB/OL]. http://www.nhc.gov.cn/, 2024-06-12. |
[2] | 中华医学会肝病学分会. 戊型肝炎防治共识[J]. 中华肝脏病志, 2022, 30(8): 820-831. |
[3] | Nasir, M. and Wu, G.Y. (2020) HEV and HBV Dual Infection: A Review. Journal of Clinical and Translational Hepatology, 8, 1-9. https://doi.org/10.14218/jcth.2020.00030 |
[4] | Heemelaar, S., Hangula, A.L., Chipeio, M.L., Josef, M., Stekelenburg, J., van den Akker, T.H., et al. (2021) Maternal and Fetal Outcomes of Pregnancies Complicated by Acute Hepatitis E and the Impact of HIV Status: A Cross-Sectional Study in Namibia. Liver International, 42, 50-58. https://doi.org/10.1111/liv.15076 |
[5] | Ma, Z., de Man, R.A., Kamar, N. and Pan, Q. (2022) Chronic Hepatitis E: Advancing Research and Patient Care. Journal of Hepatology, 77, 1109-1123. https://doi.org/10.1016/j.jhep.2022.05.006 |
[6] | 陈晓云, 刘晓慧, 宋静静, 等. 急性戊型肝炎肝衰竭不良预后的影响因素分析[J]. 北京医学, 2022, 44(10): 935-938. |
[7] | 中华医学会感染病学分会, 肝衰竭与人工肝学组. 肝衰竭诊治指南(2018年版) [J]. 中华肝脏病杂志, 2019, 27(1): 18-26. |
[8] | Cheng, S. (2013) Influence of Chronic HBV Infection on Superimposed Acute Hepatitis E. World Journal of Gastroenterology, 19, Article 5904. https://doi.org/10.3748/wjg.v19.i35.5904 |
[9] | Chow, C., Tsang, S.W., Tsang, O.T., Leung, V.K., Fung, K.S., Luk, W., et al. (2014) Comparison of Acute Hepatitis E Infection Outcome in Patients with and without Chronic Hepatitis B Infection: A 10 Year Retrospective Study in Three Regional Hospitals in Hong Kong. Journal of Clinical Virology, 60, 4-10. https://doi.org/10.1016/j.jcv.2014.01.024 |
[10] | Fang, L., Zhang, J., Chen, H., Lv, F., Yu, Y. and Du, X. (2022) Epidemiological Characteristics and Clinical Manifestations of Hepatitis E in a Tertiary Hospital in China: A Retrospective Study. Frontiers in Microbiology, 12, Article 831968. https://doi.org/10.3389/fmicb.2021.831968 |
[11] | Wang Y., Liu H., Liu S., et al. (2019). Incidence, Predictors and Prognosis of Genotype 4 Hepatitis E Related Liver Failure: A Tertiary Nested Case-Control Study. Liver International: Official Journal of the International Association for the Study of the Liver, 39, 2291-2300. https://doi.org/10.1111/liv.14221 |
[12] | Zhang, S., Chen, C., Peng, J., Li, X., Zhang, D., Yan, J., et al. (2017) Investigation of Underlying Comorbidities as Risk Factors for Symptomatic Human Hepatitis E Virus Infection. Alimentary Pharmacology & Therapeutics, 45, 701-713. https://doi.org/10.1111/apt.13938 |
[13] | 于静静. 山东地区散发性戊型肝炎病毒感染的临床特征和结局[D]: [硕士学位论文]. 济南: 山东大学, 2017. |
[14] | 刘玉, 梅雪, 张宇一, 等. 急性戊型肝炎严重黄疸患者的临床特征及危险因素分析山东地区散发性戊型肝炎病毒感染的临床特征和结局[J]. 临床肝胆病杂志, 2021, 37(3): 565-569. |
[15] | 卢锋, 刘倩楠. 戊型肝炎临床特征研究[J]. 肝脏, 2020(7): 762-764. |
[16] | 宋立莎. 急性散发性戊型病毒性肝炎及乙戊重叠感染的研究[D]: [硕士学位论文]. 长春: 吉林大学, 2013. |
[17] | 张勋. 156例散发性急性戊型肝炎临床特征分析[D]: [硕士学位论文]. 合肥: 安徽医科大学, 2017. |
[18] | 张晓芳, 吴丛霞, 邹美银. 老年戊型病毒性肝炎121例临床特征及预后分析[J]. 交通医学, 2015, 29(6): 579-581. |
[19] | 朱冰, 游绍莉, 刘鸿凌, 等. 1489例散发性戊型肝炎患者临床分析[J]. 中国病毒病杂志, 2015, 5(3): 208-211. |
[20] | 李倩. 川北地区慢乙肝患者抗HEV-IgG血清阳性率调查附33例慢乙肝重叠感染戊肝病毒病例分析[D]: [硕士学位论文]. 南充: 川北医学院, 2021. |
[21] | 李莎莎, 高学武, 谭林. 散发性戊型肝炎85例临床分析[J]. 实用肝脏病杂志, 2013, 16(1): 69-70. |
[22] | 杜敬佩, 赵巍峰. 急性散发性戊型病毒性肝炎及乙戊重叠感染的研究[J]. 中国现代药物应用, 2015, 9(13): 67-68. |
[23] | 梁敏安. 散发性戊型病毒性肝炎31例临床观察[J]. 淮海医药, 2015, 33(1): 57-58. |
[24] | 汤曦. 协和医院171例急性散发型戊型病毒性肝炎临床特征分析[D]: [硕士学位论文]. 武汉: 华中科技大学, 2014. |
[25] | 温丽珍, 沈秦. 戊型肝炎107例临床分析[J]. 安徽医学, 2012, 33(7): 874-875. |
[26] | 潘春燕, 黄呈辉, 谢春英, 等. 散发性戊型病毒性肝炎71例临床研究[J]. 中国热带医学, 2014, 14(2): 225-226+255. |
[27] | 陈姬秀, 徐浩, 朱恩纳, 等. 散发性戊型肝炎66例临床分析[J]. 实用肝脏病杂志, 2012, 15(1): 53-54. |
[28] | 陈珂, 陈榕, 王晓琳, 等. 急性重症戊型肝炎临床特征及危险因素分析[J]. 肝脏, 2021, 26(11): 1221-1223+1249. |
[29] | 陈吐芬, 张波, 张艳, 等. 散发性戊型肝炎的流行病学及临床特征分析[J]. 肝脏, 2022, 27(3): 296-301. |
[30] | 耿家宝, 王敏, 刘倩楠, 等. 我国东部地区戊型肝炎的流行病学特点[J]. 肝脏, 2016, 21(1): 48-51. |
[31] | Hamid, S.S., Atiq, M., Shehzad, F., Yasmeen, A., Nissa, T., Salam, A., et al. (2002) Hepatitis E Virus Superinfection in Patients with Chronic Liver Disease. Hepatology, 36, 474-478. https://doi.org/10.1053/jhep.2002.34856 |
[32] | Kumar Acharya, S., Kumar Sharma, P., Singh, R., Kumar Mohanty, S., Madan, K., Kumar Jha, J., et al. (2007) Hepatitis E Virus (HEV) Infection in Patients with Cirrhosis Is Associated with Rapid Decompensation and Death. Journal of Hepatology, 46, 387-394. https://doi.org/10.1016/j.jhep.2006.09.016 |
[33] | Wang, T., Tan, W., Wang, X., Zheng, X., Huang, Y., Li, B., et al. (2022) Role of Precipitants in Transition of Acute Decompensation to Acute-on-Chronic Liver Failure in Patients with HBV-Related Cirrhosis. JHEP Reports, 4, Article 100529. https://doi.org/10.1016/j.jhepr.2022.100529 |
[34] | Wedemeyer, H., Pischke, S. and Manns, M.P. (2012) Pathogenesis and Treatment of Hepatitis E Virus Infection. Gastroenterology, 142, 1388-1397.e1. https://doi.org/10.1053/j.gastro.2012.02.014 |
[35] | Kilonzo, S.B., Wang, Y., Jiang, Q., Wu, W., Wang, P., Ning, Q., et al. (2019) Superinfective Hepatitis E Virus Infection Aggravates Hepatocytes Injury in Chronic Hepatitis B. Current Medical Science, 39, 719-726. https://doi.org/10.1007/s11596-019-2097-0 |
[36] | Wasuwanich, P., Ingviya, T., Thawillarp, S., Teshale, E.H., Kamili, S., Crino, J.P., et al. (2021) Hepatitis E-Associated Hospitalizations in the United States: 2010-2015 and 2015-2017. Journal of Viral Hepatitis, 28, 672-681. https://doi.org/10.1111/jvh.13458 |
[37] | Fujii, H. and Kawada, N. (2020) The Role of Insulin Resistance and Diabetes in Nonalcoholic Fatty Liver Disease. International Journal of Molecular Sciences, 21, Article 3863. https://doi.org/10.3390/ijms21113863 |
[38] | Kamar, N., Izopet, J., Pavio, N., Aggarwal, R., Labrique, A., Wedemeyer, H., et al. (2017) Hepatitis E Virus Infection. Nature Reviews Disease Primers, 3, Article 17086. https://doi.org/10.1038/nrdp.2017.86 |