中国儿童手足口病重复感染状况的Meta分析

A Meta-analysis of recurrent infections prevalence of hand-foot-and-mouth disease among children in China

目的了解中国儿童手足口病重复感染率,为进一步完善手足口病防控策略及措施提供参考。方法在线检索中国学术期刊全文数据库、万方知识服务平台、维普资讯、Pub Med和Web of Science数据库,得到文献共计196篇。根据关于疾病患病率或发病率研究质量评价准则进行质量评价。采用Comprehensive Meta-Analysis进行数据分析,选择随机效应模型估计合并效应值、对研究年限、发表年限、样本量、重复病例判断标准、重复感染次数、纬度和年平均温度进行亚组分析以探索异质性,Egger线性回归法判断是否存在发表偏倚,对剔除文献前后合并效应值的变化进行敏感性分析。结果最终纳入31篇文献,手足口病重复感染合并率为2.25%(95%CI=1.59%～3.18%),研究间异质性较大(I2=99.87,P=0.000)。研究中不存在发表偏倚(t=1.983,P=0.057)。敏感性分析显示研究结果较为稳健可信。亚组分析结果显示,样本量、研究年限、重复病例判断标准、纬度和年均温度等因素会对研究结果造成一定的影响。结论中国手足口病重复感染率地区差异较大,重复感染合并率的异质性来源将是进一步探索的重点。

Objective To estimate the prevalence of recurrent infection of hand-foot-and-mouth disease（ HFMD） by Metaanalysis. Methods By using Chinese Web of Knowledge, Wanfang, Weipu, Pub Med, and Web of Science databases, a systematic literature search with keywords included（ ＂repeated infection＂ OR recurred OR reoccurrence OR ＂multiple infection＂ OR ＂multiple infection＂ OR ＂reinfection＂ OR ＂reoccurring infection＂ OR ＂ recurrent infection＂） AND（ ＂ HFMD＂ OR ＂ hand-foot-and-mouth Disease＂） AND ＂rate＂ both in Chinese and English. The quality of each paper was evaluated with ＂ critical appraisal of the health research literature： prevalence or incidence of a health problem＂. Random-effects Meta-analysis was used to estimate recurrent infection prevalence of HFMD by comprehensive Meta-analysis. Subgroup analyses were conducted by study years, study location,publication year, sample size, standard of repeated infection, repeated infection times, gratitude and average temperature per year to explore the heterogeneity. Egger test were performed to evaluate the publication bias. Sensitivity analysis was evaluated by iteratively removing one study at a time and comparing the recalculated combined estimates. Results Thirty-one studies were included in the analysis. The combined prevalence of recurrent infection of HFMD was 2.25%（ 95%CI = 1.59%-3.18%）. Cochran＇s Q test showed a high degree of heterogeneity across studies（ I^2= 99.87, P = 0.000）. Subgroup analysis estimated that the heterogeneity had a certain distinction at the indexes of sample size, study years, standard of repeated infection, repeated infection times, gratitude and average temperature per year. Conclusion Significant regional differences in recurrent infection of HFMD are found across China. Further investigation should focus on the sources of heterogeneity.