人巨细胞病毒感染和血清TNF-α、IL-1、IL-6水平与自然流产相关性的Meta分析

The Risk of Human Cytomegalovirus Infection and Serum TNF-α, IL-1 and IL-6 Levels during Spontaneous Abortion: A Meta-Analysis

通过Meta分析方法评估人巨细胞病毒(HumanCytomegalovirus,HCMV)感染和血清TNF-α、IL-1和IL-6水平与自然流产发生风险的相关性,为育龄妇女优生优育临床实践提供理论参考.检索中国知网(CNKI)、维普(VIP)、万方(Wanfang)、PubMed、WebofScience、Cochrane数据库截至2022年4月10日,HCMV感染与自然流产及免疫因子之间相关性的文献,根据纳入和排除标准筛选文献,利用Revman5.4软件对数据进行统计分析.结果显示自然流产患者比正常妊娠孕妇有更高的HCMV阳性率(OR6.97,95%CI4.66~10.42,P<0.00001),以及血清TNF-α水平(SMD2.69,95%CI2.36~3.82,P<0.00001)和IL-1水平(SMD4.81,95%CI2.20~7.42,P<0.00001),然而血清IL-6水平无显著差异(SMD0.37,95%CI-2.80~3.55,P=0.82).此外,相比HCMV阴性患者,HCMV阳性的自然流产患者有更高血清TNF-α水平(SMD1.45,95%CI0.88~2.02,P=0.0004)、IL-1水平(SMD 5.11,95%CI1.86~8.36,P<0.00001)和IL-6水平(SMD4.28,95%CI1.01~7.55,P<0.00001).研究表明HCMV感染会增加自然流产发生几率,该病毒感染所致自然流产可能与血清TNF-α和IL-1水平上调相关,上述结论仍需更多高质量研究予以验证.

In this study, the impact of human cytomegalovirus(HCMV) infection and serum TNF-α,IL-1 and IL-6 levels on spontaneous abortion(SA) was evaluated by means of Meta analysis, which would provide theoretical support for good prenatal and postnatal care. Literatures on the association among HCMV infection, SA, and immune factors were searched from CNKI,VIP,Wanfang, PubMed, Web of Science and Cochrane databases up to April 10,2022,and screened according to the inclusion and exclusion criteria.Revman 5.4 software was used for statistical analyses. Compared with normal pregnant group, SA patients had significantly higher rate of HCMV infection(OR 6.97,95%CI 4.66~10.42,P<0.000 01) as well as higher serum TNF-α levels(SMD 2.69,95%CI 2.36~3.82,P<0.000 01) and IL-1 levels(SMD 4.81,95%CI 2.20~7.42,P<0.000 01),whereas serum IL-6 levels(SMD 0.37,95%CI-2.80~3.55,P=0.82) were not statistically different. In addition, HCMV positive SA patients had higher serum TNF-α(SMD 1.45,95%CI 0.88~2.02,P=0.000 4),IL-1(SMD 5.11,95%CI 1.86~8.36,P<0.000 01),and IL-6 levels(SMD 4.28,95%CI 1.01~7.55,P<0.000 01) than HCMV negative SA patients. Our study indicated that maternal HCMV infection increased the risk of SA,and SA caused by this viral infection may be associated with upregulation of serum TNF-α and IL-1 levels. More high quality studies are needed for further verification of this conclusion.