2种方案预防肝移植术后巨细胞病毒感染及安全性评价

Systematic evaluation of efficacy and safety of two strategies on preventing CMV disease in liver transplant recipients

目的:系统评价2种方案预防肝移植术后巨细胞病毒(CMV)病的疗效及安全性。方法:计算机检索PubMed、EMbase、Cochrane图书馆临床对照试验资料库、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普和万方数据库,检索时间均从建库至2012年12月,手工检索相关文献。收集评价2种方案预防肝移植患者术后CMV病疗效及安全性的随机对照试验(RCT)。对符合纳入标准的临床研究进行质量评价和资料提取后,采用RevMan 5.1软件进行Meta分析。结果:共纳入9个RCT,包括849例患者。Meta分析结果显示:(1)采用普遍性预防能有效减少肝移植术后CMV病发生率[RR=0.33,95%CI(0.22,0.51),P<0.000 01],且不增加术后不良反应发生率和总死亡率;(2)采用先发治疗能有效减少肝移植术后CMV病发生率[RR=0.30,95%CI(0.10,0.94),P=0.04];(3)采用普遍性预防能有效减少D±/R+患者术后CMV病发生率[RR=0.24,95%CI(0.12,0.46),P<0.0001]。(4)对于D+/R-患者,只有采用普遍性预防才能有效减少术后CMV病发生率[RR=0.47,95%CI(0.22,0.99),P=0.05],而采用先发治疗则无效。结论:2种方案都能有效预防肝移植术后CMV病的发生,但对于高危人群只有采用普遍性预防措施才能有效。

OBJECTIVE To evaluate the efficacy and safety of two strategies（universal prophylaxis and preemptive prophylaxis）on preventing CMV disease in liver transplant recipients.METHODS PubMed,EMbase,Central Register of Controlled Trials,CBM,CNKI,VIP and WanFang Database were retrieved from the date of establishment until December 2012.We also handsearched the relevant journals.And we collected the randomized controlled trials（RCTs）that evaluated the efficacy and safety of two strategies on preventing CMV disease in liver transplant recipients.Data were extracted independently by two reviewers.Statistical analysis was performed with RevMan 5.1.RESULTS Nine RCTs involving 849 patients were included.The results of Meta-analyses showed as following：（1）The universal prophylaxis group was more effective than the control group in decreasing incidence of CMV disease[RR=0.33,95%CI（0.22,0.51）,P〈0.000 01].While there was no significant difference between the two groups in incidence of adverse reactions and all mortality;（2）The preemptive prophylaxis group statistically significantly decreased incidence of CMV disease than the control group[RR=0.30,95%CI（0.10,0.94）,P=0.04];（3）The universal prophylaxis group was more effective than the control group in decreasing incidence of CMV disease[RR=0.24,95%CI（0.12,0.46）,P〈0.000 1]in D±/R＋ patients;（4）For D＋/R-patients,the universal prophylaxis group was more effective than the control group in decreasing incidence of CMV disease[RR=0.47,95%CI（0.22,0.99）,P=0.05].While there was no significant difference between the preemptive prophylaxis group and the control group in decreasing incidence of CMV disease.CONCLUSION Both two strategies were effective in decreasing incidence of CMV disease in liver transplant recipients.However,for D＋/R-patients,only the universal prophylaxis was effective in decreasing incidence of CMV disease.