人巨细胞病毒感染与难治性溃疡性结肠炎相关性的系统评价  

Relationship between human cytomegalovirus infection and refractory ulcerative colitis: A meta-analysis

作　　者：赵海明[1] 赵正兰[1] 罗玉明[1] 郭睿[1] 沈虹[1] 

机构地区：[1]四川省医学科学院 四川省人民医院城东病区消化内科,四川省成都市610101

出　　处：《世界华人消化杂志》2014年第36期5721-5731,共11页World Chinese Journal of Digestology

摘　　要：目的:应用Meta分析评价人巨细胞病毒(human cytomegalovirus,HCMV)感染与难治性溃疡性结肠炎(ulcerative colitis,UC)的相关性,探讨难治性UC患者合并HCMV感染后抗HCMV治疗的必要性.方法:计算机检索中国知网(China National K n o w l e d g e I n t e r n e t,C N K I)、P u b M e d、M e d l i n e、万方等电子数据库,检索时限为1990-01/2013-12.搜集H C M V感染与难治性U C相关性研究文献,逐篇评价纳入文献的质量,采用Rev Man4.2版软件进行Meta分析;利用漏斗图对发表偏倚进行分析.结果:共纳入18篇文献(外文15篇,中文3篇),涉及831例患者.对其中纳入的7篇文献分别从结肠组织和血液分子水平两方面进行分析.对纳入的有关HCMV感染与UC的相关性6篇文献在结肠组织水平方面进行分析,结果提示:UC组与对照组的HCMV感染率差异有统计学意义(OR=10.62,95%CI:4.79-23.54,P<0.00001);对纳入的有关HCMV感染与UC的相关性3篇文献在血液分子水平方面进行分析,结果提示:UC组与对照组的HCMV感染率差异有统计学意义(OR=3.22,95%CI:1.48-7.00,P=0.003);对纳入的有关HCMV感染与UC出现激素耐药的相关性6篇文献进行分析,结果提示:HCMV感染与UC患者发生激素难治呈正相关,有统计学意义(OR=8.88,95%CI:4.43-17.17,P<0.00001);对纳入有对照试验的3篇有关抗HCMV治疗与UC有效性文献进行分析,结果提示,抗HCMV治疗HCMV阳性的难治性UC组与对照组比较,差异有统计学意义(OR=7.53,95%CI:1.59-35.72,P=0.01).15篇文献评价了抗HCMV治疗对CMV阳性激素难治性UC患者的有效性,结果显示总体缓解率可达74%.漏斗图提示所有文献均存在发表性偏倚.结论:难治性UC与HCMV感染(无论在血液分子水平还是结肠组织病理标本)呈正相关,HCMV可以使难治性UC的病情变复杂,出现激素抵抗.进行抗病毒治疗可以提高HCMV阳性激素难治性UC患者的总体缓解率,但尚需更多高质量、大样本、前瞻性、多中心的研究结�AIM： To investigate the relationship between human cytomegalovirus （HCMV） infection and refractory ulcerative colitis （UC）, and evaluate the necessity of antiviral therapy in refractory UC patients with HCMV infection. METHODS： We searched Medline, PubMed, CNKI and Wanfang databases till 2013 to retrieve relevant studies. Meta-analyses were performed for the included case-control studies using RevMan4.2 software after strict screening to estimate odds ratio （OR） and 95% confidence interval （CI） for the association between HCMV infection and refractory UC. We also performed heterogeneity test, sensitivity analysis and publication bias assessment. RESULTS： Eighteen eligible studies, including 15 carried out by foreigners and 3 by Chinese researchers, were included in the meta-analysis, involving 831 patients with UC. Seven included studies were analyzed at both blood and intestinal tissue levels. Six studies on HCMV infection and refractory UC were also collected for analysis at intestinal tissue level. The results of meta-analysis showed that there was a significant difference in the HCMV infection rate between patients with refractory UC and health controls （OR = 10.62, 95%CI： 4.79-23.54, P 〈 0.00001）. At the blood level, three studies on HCMV infection and refractory UC were collected. It was showed that there was a significant difference in the HCMV infection rate between patients with refractory UC and health controls （OR = 3.22, 95%CI： 1.48-7.00, P = 0.003）. Six studies on patients with active UC who were infected with HCMV and non-responsive to steroids were collected. The results of meta-analysis showed that the incidence of hormone resistance in patients with refractory UC was positively correlated with the HCMV infection rate （OR = 8.88, 95%CI： 4.43-17.17, P 〈 0.00001）. Three studies on whether antiviral therapy could increase platelet count in patients with refractory UC were collected. It was showed that the group treated by antiviral therapy was superior

关 键 词：人巨细胞病毒 溃疡性结肠炎 炎症性肠病 难治性 Meta分析 

分 类 号：R574.62[医药卫生—消化系统]