肾移植术后抢先治疗和普遍预防对预防巨细胞病毒感染的Meta分析  

Clinical values of preemptive therapy versus universal prophylaxis in the prevention of cytomegalovirus infection post kidney transplantation： a systematic review and Meta-analysis

作　　者：王垒[1] 彭贵主[1] 叶殷发[1] Wang Lei;Peng Guizhu;Ye Qifa(Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Disease of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan 430071, China)

机构地区：[1]武汉大学中南医院,武汉大学肝胆疾病研究院,武汉大学移植医学中心,移植医学技术湖北省重点实验室,430071

出　　处：《中华泌尿外科杂志》2018年第4期294-299,共6页Chinese Journal of Urology

摘　　要：目的系统评价肾移植术后巨细胞病毒（CMV）感染预防中抢先治疗和普遍预防两种方案的临床价值。方法计算机检索Pubmed、EMbase、sinoMed、Web of Science、the Cochrane Central Register of Controlled Trials（CENTRAL）、万方数据库、中国知网以及维普数据库等，纳入比较抢先治疗和普遍预防两种方案降低肾移植受者术后CMV感染和CMV病发生率的临床对照试验。检索时限均从建库至2016年12月。应用比值比（OR）、均值差（MD）和95%CI评价结局指标。用Review Manager 5.3软件进行荟萃分析。结果本系统评价共纳入11项研究，包含2 560例患者。荟萃分析结果表明，普遍预防在肾移植术后总的CMV感染和CMV病发生率方面均优于抢先治疗（OR＝3.38，95%CI 2.13～5.36，P〈0.001；OR＝1.69，95%CI 1.14～2.48，P＝0.008）；而在迟发型CMV感染及迟发型CMV病发生率方面抢先治疗优于普遍预防（OR＝0.07，95%CI 0.02～0.19，P〈0.001；OR＝0.08，95%CI 0.01～0.60，P＝0.01）。但是，二者在肾移植术后的短期生存效益包括术后1年的受者、移植物生存率（P＝0.82，P＝0.84）及肾功能方面（P＝0.47）差异均无统计学意义。在控制抗病毒药物不良反应方面，抢先治疗优于普遍预防（OR＝0.33，95%CI 0.15～0.72，P＝0.006）。结论在CMV感染的预防效果方面，抢先治疗并不优于普遍预防；但是抢先治疗大大降低了抗病毒药物不良反应发生的风险。ObjectiveTo evaluate the clinical efficacy of preemptive therapy versus universal prophylaxis in prevention of cytomegalovirus（CMV） infection post kidney transplantation.MethodsDatabases including the PubMed, EMbase, sinoMed, Web of Knowledge, the Cochrane Central Register of Controlled Trails （CENTRAL） and other databases were searched up to December 2016 for controlled clinical studies which involved preemptive therapy and universal prophylaxis. Odds ratio （OR） and mean difference （MD） with 95% confidence interval （CI） was performed using Review Manager 5.3 software to synthesize the results.Results11 studies with a total of 2 560 patients were included in this Meta-analysis. Results showed that universal prophylaxis was superior to preemptive therapy in the total CMV infection and CMV disease（OR=3.38, 95%CI 2.13-5.36, P〈0.001; OR=1.69, 95%CI 1.14-2.48, P=0.008）, otherwise it was on the contrary in the late onset CMV infection and CMV disease （OR=0.07, 95%CI 0.02~0.19, P〈0.001; OR=0.08, 95%CI 0.01-0.60, P=0.01）. However, there was no significance in the short outcomes between the two groups including 1-year recipient and graft survival and renal function. In addition, preemptive therapy was superior to universal prophylaxis in the adverse events （OR=0.33, 95%CI 0.15-0.72, P=0.006）.ConclusionsThere was no significant difference between the two prophylaxis in the prevention of CMV infection, but preemptive therapy was superior to universal prophylaxis in the prevention of anti-virus adverse effects.

关 键 词：肾移植 巨细胞病毒感染 抢先治疗 普遍预防 荟萃分析 

分 类 号：R699.2[医药卫生—泌尿科学]