巨细胞病毒感染母乳消毒方法及效果Meta分析

Research on disinfection methods of cytomegalovirus infected breast milk:a meta-analysis

目的 评价不同消毒方法对母乳中巨细胞病毒(CMV)的灭活作用。方法 计算机检索PubMed、中国知网等数据库,收集融冻、热力消毒等不同消毒方法处理CMV感染母乳的随机对照试验、队列研究和体外研究,采用RevMan5.4.1软件进行Meta分析,对消毒效果进行定性及定量评价。结果 共纳入15个研究,包括1个随机对照研究,4个队列研究,10个体外研究。热力消毒母乳喂养的极低出生体重早产儿比新鲜母乳喂养和融冻母乳喂养者生后CMV发生率低(OR=0.09,P<0.01),晚发型败血症(OR=0.87,P=0.58)和坏死性小肠结肠炎(OR=1.23,P=0.55)的发生率无统计学差异。体外研究显示巴氏消毒法、短时热消毒、微波加热法和紫外线照射法在一定条件下能完全灭活母乳中的CMV,但融冻法则无法完全灭活。结论 热力消毒是灭活母乳CMV的有效方法。

Objective To evaluate the effect of different disinfection methods on cytomegalovirus(CMV) in breast milk.Methods Data bases including PubMed, and CNKI were searched to collect randomized controlled trials, cohort studies and in vitro studies on the effect of different disinfection methods like freeze-thawing, heat treatment for CMV infected breast milk.The disinfection effect were evaluated qualitatively and quality and the extracted data was analyzed by RevMan5.4.1.Results Fifteen studies were selected, including 1 randomized controlled study, 4 cohort studies and 10 in vitro studies.The incidence of CMV infection in very low birth weight preterm infants using breast milk after heat treatment was lower than that in fresh breast milk and freeze-thawing breast milk feeding(OR=0.09,P<0.0001),and there was no significant difference in the incidence of late-onset sepsis(OR=0.87,P=0.58) and necrotizing enterocolitis between them(OR=1.23,P=0.55).In vitro studies also indicated that pasteurization, high-temperature short-time heat treatment, microwave heating and ultraviolet irradiation could completely inactivate CMV in breast milk under certain conditions, while freeze-thawing treatment could not completely eliminate CMV infection.Conclusions Heat treatment is the most effective way to eliminate CMV in breast milk.