造血干细胞移植后巨细胞病毒感染的风险因素:一项 Meta 分析。

Si-Ting Wu, Chun-Li Wang, Li Wang, Cai-Yun Zhang
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引用次数: 0

摘要

巨细胞病毒(CMV)感染是造血干细胞移植(HSCT)后最常见的病毒感染。然而,关于相关风险因素的研究观点不一,没有明确的结论。因此,本研究旨在评估造血干细胞移植后CMV感染的风险变量,以便为治疗提供建议。本研究检索了国家知识基础设施[CNKI]、中国生物医学文献数据库[SinoMed]、万方数字期刊[WANFANG]和中国科技期刊[VIP]数据库,以及PubMed、Embase、CENTRAL和Web of Science数据库。检索关键词为《护理及相关健康文献累积索引》(CINAHL)。检索时间跨度为数据库创建时至 2023 年 2 月。根据纳入和排除标准,由两名研究人员独立选择文献、检索数据并评估偏倚风险。纳入研究的方法学质量采用纽卡斯尔-渥太华量表(NOS)进行评估。共检索到 1,038 篇文献,最终纳入了其中的 18 项研究。荟萃分析的最终结果显示,存在以下七个风险因素:移植后急性移植物抗宿主病(aGVHD)II-IV 级(II-IV)[几率比=3.39,95% CI(2.13,5.41),p 300 ng/ml][OR=3.79,95% CI(1.24,11.65),p 300 ng/ml]、年龄、中性粒细胞缺乏时间、移植前受者感染 CMV 和真菌感染。然而,这些风险变量背后的机制尚不清楚。有必要开展进一步研究,以了解风险因素,并加强对存在这些风险因素的患者的护理,预防或控制感染。关键词:造血干细胞造血干细胞移植 巨细胞病毒感染 风险因素 Meta分析
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Risk Factors for Cytomegalovirus Infection after Haematopoietic Stem Cell Transplantation: A Meta-Analysis.

Cytomegalovirus (CMV) infection is the most common viral infection after haematopoietic stem cell transplantation (HSCT). However, studies on related risk factors give different views without any clear conclusion. Therefore, the purpose of this study was to evaluate the risk variables of CMV infection after HSCT in order to provide recommendations for therapeutic treatment. The National Knowledge Infrastructure [CNKI], Chinese Biomedical Literature database [SinoMed], Wanfang Digital Periodicals [WANFANG] and China Science and Technology Journal [VIP] databases, as well as PubMed, Embase, CENTRAL, Web of Science databases were searched. The search keyword was Cumulative Index of Nursing and Related Health Literature (CINAHL). The search time spanned from the time when the database was created to February 2023. Based on inclusion and exclusion criteria, two researchers independently chose the literature, retrieved data, and assessed the bias risk. The methodological quality of the included studies was assessed by the Newcastle Ottawa scale (NOS). A total of 1,038 literatures were retrieved, of which, 18 studies were finally included. The final results of meta-analysis showed that there were seven risk factors as follows: Acute graft-versus-host disease (aGVHD) grades II-IV (II-IV) [odds ratio = 3.39, 95% CI (2.13, 5.41), p <0.05]; ant-thymocyte globulin (ATG) administration in treatment [odds ratio = 2.53, 95% CI (1.41, 4.53), p <0.05]; cyclosporine level after transplantation (>300 ng/ml) [OR = 3.79, 95% CI (1.24, 11.65), p <0.05]; age [odds ratio = 1.83, 95% CI (1.06, 3.15), p <0.05]; neutrophil deficiency time [odds ratio = 6.58, 95% CI (2.24, 19.30), p <0.05]; CMV infection in recipients before transplantation [odds ratio = 6.32,95% CI (4.03, 9.90), p <0.05]; fungal infection [odds ratio = 2.63, 95% CI (1.09, 6.34), p <0.05]. This study preliminarily revealed that CMV infection after HSCT is related to aGVHD (II-IV), ATG administration in pretreatment, cyclosporine level (>300 ng/ml) after transplantation, age, neutrophil deficiency time, CMV infection in recipients before transplantation and fungal infection. However, the mechanisms behind the risk variables are unclear. Further research is necessary to understand the risk factors and to enhance the care of patients with these risk factors to prevent or control infection. Key Words: Haematopoietic stem cell transplantation, Cytomegalovirus infection, Risk factors, Meta-analysis.

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