溃疡性结肠炎患者巨细胞病毒感染或再激活危险因素的Meta分析

Risk factors of cytomegalovirus infection or reactivation in ulcerative colitis patients:a Meta-analysis

目的探讨溃疡性结肠炎(ulcerative colitis,UC)患者发生巨细胞病毒(cytomegalovirus,CMV)感染或再激活的危险因素。方法计算机检索英文数据库PubMed、Cochrane、Embase及中文数据库中国知网(CNKI)、万方数据知识服务平台(Wanfang)、中国生物医学文献服务系统(SinoMed)与维普期刊资源整合服务平台(VIP),收集2017年3月之前国内外公开发表的关于UC与CMV感染的相关文献。由2人分别采用纽卡斯尔-渥太华量表(New castle-Ottawa Scale,NOS)对所纳入文献的质量评价。根据纳入与排除标准筛选文献,提取资料和评价质量后采用RevMan5.3软件对纳入文献进行Meta分析,采用stata 12.0软件进行egger检验评估发表偏倚。结果共检索到1497篇文献,按照纳入和排除标准筛选出18篇文献,全部为病例对照研究,所纳入研究均为高质量研究。重度UC发生CMV感染或再激活的风险是轻中度UC的1.45倍,全结肠UC发生CMV感染或再激活的风险是仅累及左半结肠、直肠UC患者的1.54倍,合并OR值(95%CI)分别为1.45(1.02~2.05)、1.54(1.05~2.27)。中年发病的UC患者发生CMV感染或再激活的风险高于青年UC患者,合并MD值(95%CI)为4.60(2.13~7.07)。糖皮质激素、免疫抑制剂(硫唑嘌呤、环孢素A、甲氨蝶呤等)治疗是UC患者发生CMV感染或再激活的危险因素,合并OR值(95%CI)分别为3.87(2.70~5.53)、2.07(1.29~3.32)。UC患者的病程、5-ASA/SASP、英夫利西单抗治疗与CMV感染或再激活无统计学意义,合并OR值(95%CI)分别为-1.20(-2.64~0.24)、0.94(0.61~1.42)、1.50(0.65~3.44)。结论重度UC、全结肠病变、糖皮质激素及免疫抑制剂治疗是UC患者发生CMV感染或再激活的危险因素;中年发病的UC患者发生CMV感染或再激活的风险高于青年UC患者。

Objective To explore the risk factors of cytomegalovirus(CMV)infection or reactivation in ulcerative colitis(UC)patients.Methods We performed a search at the databases of Pubmed,Cochrane,Embase,CNKI,Wanfang,SinoMede and VIP up to March 2017.A search strategy was constructed by using a combination of the following words:"inflammatory bowel disease or IBD"or"ulcerative colitis or UC"and"cytomegalovirus or CMV".Literature was screened according to the inclusion and exclusion criteria and statistics was analyzed using RevMan 5.3 software provided by Cochrane collaboration network and analyzed using Stata 12.0 software to evaluate publication bias.Results After searching and screening,we included 18 case-control studies finally.Meta-analysis showed that the risk of CMV infection or reactivation in severe UC was 1.45 times that in mild to moderate UC and the risk in whole colon was 1.54 times that of patients with left colon and rectum with the pooled OR values as 1.45(1.02-2.05)and 1.54(1.05-2.27).The risk of CMV infection in middle-aged patients with UC was higher than that in young patients with the pooled MD values of 4.60(2.13-7.07).The therapies with glucocorticoid and immunosuppressive agents such as azathioprine,cyclosporine and methotrexate were high risk factors of CMV infection or reactivation in UC patients,with the pooled OR values as 3.87(2.70-5.53)and 2.07(1.29-3.32),but the duration of UC,treatment with 5-Amino salicylic acid/salazosulfapyridine(5-ASA/SASP)and infliximab had no statistically significant correlation with the CMV infection or reactivation in UC patients,with the pooled OR values as-1.20(-2.64-0.24),0.94(0.61-1.42)and 1.50(0.65-3.44).Conclusions In patients with severe UC,whole colon lesions and the therapy with glucocorticoid and immunosuppressive agents were the risk factors of CMV infection or reactivation.The risk of CMV infection or reactivation in middle-aged patients was higher than that in young patients.