The prognosis of hepatitis E superinfection in hospitalized chronic hepatitis B patients in China:A systematic review and Meta-analysis
SU Ying-ying and HUANG Yue contributed equally to this article
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摘要:
目的 评估中国慢性乙型肝炎(chronic hepatitis B, CHB)患者中戊型肝炎病毒(hepatitis E virus, HEV)重叠感染的发生和转归情况。 方法 检索PubMed、中国知网(CNKI)以及万方数据资源库, 收集2008-2019年中国关于CHB患者中HEV重叠感染的文献和相关文献的参考文献, 按照纳入排除标准进行文献筛选, 对纳入的文献进行数据提取、质量评价和统计分析, 使用R 3.5.2和Revman 5.3软件进行异质性检验(统计量I2)、合并率和比值比(odds ratio, OR)的计算。 结果 共纳入28篇文献。在CHB住院患者中HEV重叠感染率为13.6%(95% CI:12.5%~14.9%)。重叠感染HEV的CHB住院患者(CHB-HEV住院患者)中肝衰竭发生率为34.7%(95% CI:29.6%~40.1%), 发生风险均高于单纯CHB患者(OR=10.9, 95% CI:6.8~17.4)、重叠感染甲型肝炎病毒(hepatitis A virus, HAV)的CHB住院患者(CHB-HAV住院患者)(OR=3.8, 95% CI:2.4~6.2)以及单纯戊型肝炎患者(OR=5.1, 95% CI:3.8~6.8)。CHB-HEV住院患者病死率为13.8%(95% CI:10.3~17.8), 病死风险均高于单纯CHB患者(OR=8.5, 95% CI:4.0~18.3)、CHB-HAV住院患者(OR=14.4, 95% CI:4.8~42.9)以及单纯戊型肝炎患者(OR=4.4, 95% CI:3.0~6.4)。 结论 我国CHB住院患者中重叠感染HEV较常见, 是肝衰竭和死亡的重要诱因。 Abstract:Objective To evaluate the prevalence and prognosis of hepatitis E virus(HEV) superinfection in patients with chronic hepatitis B(CHB). Methods Electronic databases of Pubmed, CNKI, and Wanfang were searched, and references of the relevant articles for literatures associated with HEV superinfection in CHB patients in China published during 2008-2019 were screened. Studies which met the inclusion and exclusion criterias were selected and related data were pooled for analysis. The R 3.5.2 and Revman 5.3 were used to measure heterogeneity with the I2 statistic and pooled incidence and odds ratio(OR). Results 28 literatures were eligible for inclusion. The results showed the rate of HEV superinfection in hospitalized CHB(CHB-HEV) patients was 13.6%(95%CI: 12.5%-14.9%). The pooled incidence of liver failure in CHB-HEV patients was 34.7%(95%CI:29.6%-40.1%), which was higher than CHB patients(OR=10.9, 95%CI: 6.8-17.4), CHB patients superinfected with hepatitis A virus(CHB-HAV)(OR=3.8, 95%CI: 2.4-6.2), and hepatitis E patients(OR=5.1, 95%CI: 3.8-6.8). The pooled mortality of CHB-HEV patients was 13.8%(95%CI:10.3-17.8), which was higher than CHB patients(OR=8.5, 95%CI: 4.0-18.3), CHB-HAV patients(OR=14.4, 95%CI: 4.8-42.9), and hepatitis E patients(OR=4.4, 95%CI: 3.0-6.4). Conclusion In China, HEV sueperinfection on chronic hepatitis B patients are common, and is an important cause of liver failure and death. -
Key words:
- Hepatitis B /
- Chronic /
- Hepatitis E /
- Superinfection /
- Liver failure /
- Mortality
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表 1 28篇纳入文献基本信息
Table 1. Characteristic of 28 included studies
第一作者, 年份 研究类型 人群特征 结局指标 研究周期 研究地区 研究质量评价 Zhang[8], 2018 病例-对照研究 社区人群 CHB-HEV 2014.04-2014.07 山东省 高 Lai[5], 2018 回顾性队列研究 住院患者 病死 2000.01-2016.12 香港 中 赵瑞红[9], 2018 回顾性队列研究 住院患者 CHB-HEV 1995.01-2014.12 湖北省 中 孟志杰[10], 2017 回顾性队列研究 住院患者 肝衰竭、病死 2013.01-2016.01 广西省 中 张勋[11], 2017 回顾性队列研究 住院患者 肝衰竭 2012.01-2015.12 安徽省 低 Chen[12], 2016 回顾性队列研究 住院患者 肝衰竭、病死 2009.09-2014.09 上海市 低 张丹[13], 2015 回顾性队列研究 住院患者 肝衰竭、病死 2010.06-2013.06 辽宁省 中 廖宝林[14], 2015 回顾性队列研究 住院患者 肝衰竭 2005.04-2013.06 广东省 低 杜敬佩[15], 2015 回顾性队列研究 住院患者 肝衰竭、病死 2006.02-2014.04 河南省 低 周燕[16], 2014 回顾性队列研究 住院患者 肝衰竭、病死 2010.07-2013.07 上海市 中 汤曦[17], 2014 回顾性队列研究 住院患者 肝衰竭、病死 2011.01-2012.12 北京市 低 朱鹏[18], 2014 回顾性队列研究 住院患者 病死 2003.01-2013.06 重庆市 低 Chow[6], 2014 回顾性队列研究 住院患者 肝衰竭、病死 2000.11-2012.02 香港 低 贺新春[19], 2013 回顾性队列研究 住院患者 肝衰竭、病死 2009.10-2011.10 无 中 Cheng[20], 2013 回顾性队列研究 住院患者 肝衰竭、病死 2003.01-2012.01 广东省 低 刘建湘[21], 2012 回顾性队列研究 住院患者 肝衰竭、病死 2008.05-2010.10 重庆市 低 温丽珍[22], 2012 回顾性队列研究 住院患者 病死 2007.01-2011.09 安徽省 低 姚维敏[23], 2011 回顾性队列研究 住院患者 肝衰竭、病死 2005.01-2010.01 广东省 中 魏嬛[24], 2011 回顾性队列研究 住院患者 肝衰竭、病死 2004.01-2010.12 广东省 低 阎鹏[25], 2011 回顾性队列研究 住院患者 肝衰竭 2006-2009 辽宁省 低 杨涛[26], 2010 回顾性队列研究 住院患者 肝衰竭、病死 2006.01-2007.05 辽宁省 中 李蔚莉[27], 2010 回顾性队列研究 住院患者 肝衰竭、病死 2005-2009 无 中 Zhang[28], 2010 回顾性队列研究 住院患者 肝衰竭、病死 1999.03-2007.10 广东省 低 章述军[29], 2010 回顾性队列研究 住院患者 病死 2007.01-2008.12 湖北省 中 李智[30], 2009 回顾性队列研究 住院患者 肝衰竭 2005.01-2008.07 湖北省 中 章以法[31], 2008 回顾性队列研究 住院患者 肝衰竭、病死 2004.02-2008.01 江苏省 中 王文虎[32], 2008 回顾性队列研究 住院患者 肝衰竭、病死 2000.08-2006.08 湖北省 低 夏小学[33], 2008 回顾性队列研究 住院患者 肝衰竭、病死 2003.06-2008.06 浙江省 低 
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表 2 不同肝炎患者肝衰竭发生率及病死率Meta分析
Table 2. Meta-analysis for liver failure incidence and mortality in different types of patients
患者类型 文献数量(篇) 例数(人) I2值(%) 合并模型 合并率(%)(95% CI)值 肝衰竭发生率 CHB-HEV 20 1 119 68 随机效应 34.7(29.6~40.1) 单纯CHB 6 380 0 固定效应 6.1(3.7~8.9) 单纯戊肝 13 1 240 69 随机效应 6.8(4.3~9.8) CHB-HAV 3 163 29 固定效应 16.3(10.9~22.5) 病死率 CHB-HEV 22 1 563 75 随机效应 13.8(10.3~17.8) 单纯CHB 6 331 0 固定效应 1.5(0.3~3.4) 单纯戊肝 14 1 963 76 随机效应 1.8(0.6~3.6) CHB-HAV 4 248 0 固定效应 0.9(0.0~2.8)
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表 3 CHB-HEV患者与不同对照患者对比的肝衰竭、病死风险的Meta分析
Table 3. Meta-analysis for risk factor of liver failure and death in CHE-HEV superinfection group and control groups
对照患者 文献数量(篇) 例数(人)(病例, 对照)a I2值(%) 合并模型 合并OR(95% CI)值 肝衰竭发生风险 合并对照 20 1 119, 1 783 41 固定效应 5.6(4.5~7.0) CHB对照 6 310, 380 35 固定效应 10.9(6.8~17.4) 戊肝对照 13 618, 1 240 19 固定效应 5.1(3.8~6.8) CHB-HAV对照 3 296, 163 0 固定效应 3.8(2.4~6.2) 病死风险 合并对照 20 1 260, 2 543 0 固定效应 6.1(4.4~8.5) CHB对照 6 303, 331 0 固定效应 8.5(4.0~18.3) 戊肝对照 14 813, 1 963 0 固定效应 4.4(3.0~6.4) CHB-HAV对照 4 410, 248 0 固定效应 14.4(4.8~42.9) 注:a表示合并人群CHB-HEV组人数和对照组人数。
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