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预防医学  2018, Vol. 30 Issue (6): 557-564    DOI: 10.19485/j.cnki.issn2096-5087.2018.06.005
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慢性基础疾病与人感染H7N9禽流感病死风险校正关联性的Meta分析
杨洛贤,程庆林,张琼,谢立
杭州市疾病预防控制中心,浙江 杭州 310021
Association between underlying medical conditions and fatality risk in H7N9-infected patients: a meta-analysis
YANG Luo-xian,CHENG Qing-lin,ZHANG Qiong,XIE Li
Hangzhou Center for Disease Control and Prevention,Hangzhou,Zhejiang 310021,China
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摘要 目的 探讨人感染H7N9禽流感患者病死风险与合并慢性基础疾病(UMCs)的关联。方法 以“H7N9 avian influenza”“chronic disease”“mortality”等为关键词,检索PubMed、Cochrane Library等外文数据库;以“H7N9禽流感”“慢性病”“死亡”等为关键词检索中国知网、万方医学等中文数据库,查找UMCs与人感染H7N9禽流感病死风险的相关文献,时间范围不限。采用Meta分析法计算合并风险比(OR)或校正风险比(AOR)。结果 共检索到1 934篇文献,最终纳入14个病例对照/队列研究。Meta分析结果显示,人感染H7N9禽流感患者合并UMCs的病死风险是未合并者的2.20倍(95%CI:1.76~2.76)。亚组分析结果显示,合并慢性呼吸系统疾病(OR=4.43,95%CI:1.73~11.31)、免疫抑制性疾病(OR=4.65,95%CI:1.48~44.70)、≥2种UMCs(OR=2.13,95%CI:1.26~5.97)患者病死风险较高;在≥60岁(AOR=4.83,95%CI:1.29~18.09)、男性(AOR=2.35,95%CI:1.03~5.39)、达菲治疗时间间隔>5 d(AOR=5.74,95%CI:1.15~28.66)、住院治疗时间间隔>8 d(AOR=2.72,95%CI:1.20~6.15)、发病初期双肺感染(AOR=7.95,95%CI:1.56~40.41)的人感染H7N9禽流感患者中,合并UMCs的病死风险较高。分层分析结果显示,在人感染H7N9禽流感合并UMCs的患者中,≥60岁(AOR=2.20,95%CI:1.12~4.30)、达菲治疗时间间隔>5 d(AOR=3.19,95%CI:1.56~6.53)、发病初期双肺感染(AOR=3.48,95%CI:1.74~6.95)的病死风险较高。结论 合并慢性呼吸系统疾病或免疫抑制性疾病或同时合并≥2种UMCs的人感染H7N9禽流感患者的病死风险增加,且在合并UMCs的人感染H7N9禽流感患者中,≥60岁、延迟达菲治疗和发病初期双肺感染的患者病死风险相对较高。
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杨洛贤
程庆林
张琼
谢立
关键词 人感染H7N9禽流感病死风险慢性基础疾病Meta分析    
AbstractObjective The objective of our study was to conduct meta-analyses that examined the association between H7N9-infected case-fatality risk(CFR)and underlying medical conditions(UMCs)by adjusting some potential factors variables. Methods The articles of observational studies and randomized controlled clinical trials(RCT)on the association between UMCs and the CFR of H7N9-infected patients were collected and selected according to inclusion and exclusion criteria. Meta-analysis was performed to calculate odds ratio(OR)or adjusted OR(AOR)and 95% confidence interval(CI)to assess the association between H7N9-infected CFR and UMCs. Results Among 1 934 screened articles,we identified 14 articles reporting the CFR of H7N9-infected patients based on UMCs data. The pooled summary estimates from these studies indicated that UMCs significantly increased the risk of death in H7N9 patients (OR=2.20,95%CI:1.76-2.76). Subgroup analyses showed chronic respiratory diseases (CRD,OR=4.43,95%CI:1.73-11.31),immuno-suppressive disorders(ISD,OR=4.65,95% CI:1.48-44.70),and two UMCs and above(OR=2.13,95% CI:1.26-5.97) were significantly associated with H7N9-infected CFR; while 60 years old and above (AOR=4.83,95%CI:1.29-18.09),male(AOR=2.35,95%CI:1.03-5.39),time intervals to oseltamivir treatment(over 5 days)(AOR=5.74,95%CI:1.15-28.66)and hospitalization(over 8 days)(AOR=2.72,95%CI:1.20-6.15),and initially bilateral lungs infection(AOR=7.95,95%CI:1.56-40.41)of UMCs patients who died from H7N9 infection are much greater compared with non-UMCs. Stratification analyses confirmed statistically significant increasing effects of CFR were observed in 60 years old and above(AOR=2.20,95%CI:1.12-4.30),time intervals to oseltamivir treatment(over 5 days)(AOR=3.19,95%CI:1.56-6.53),and initially bilateral lungs infection(AOR=3.48, 95%CI:1.74-6.95)compared with 0-59 years old,time intervals to oseltamivir treatment(5 days and below),and initially single lung infection respectively in H7N9-infected patients with UMCs. Conclusions We find that only CRD,ISD,and two UMCs and above are associated with increased risk of death in H7N9-infected patients. We also suggest that a high CFR is associated with 60 years old and above,delayed antiviral treatment,and initially bilateral lungs infection in H7N9-infected patients with UMCs.
Key wordsAvian influenza virus    Case-fatality risk    Underlying medical conditions    Meta-analysis
     出版日期: 2018-06-04
ZTFLH:  R181.3  
基金资助:杭州市科技局重大科技创新项目(20131813A07)
通信作者: 程庆林,E-mail:chengqinglin888@sina.com   
作者简介: 杨洛贤,本科,副主任医师,主要从事传染性疾病控制工作
引用本文:   
杨洛贤,程庆林,张琼,谢立. 慢性基础疾病与人感染H7N9禽流感病死风险校正关联性的Meta分析[J]. 预防医学, 2018, 30(6): 557-564.
YANG Luo-xian,CHENG Qing-lin,ZHANG Qiong,XIE Li. Association between underlying medical conditions and fatality risk in H7N9-infected patients: a meta-analysis. Preventive Medicine, 2018, 30(6): 557-564.
链接本文:  
http://www.zjyfyxzz.com/CN/10.19485/j.cnki.issn2096-5087.2018.06.005      或      http://www.zjyfyxzz.com/CN/Y2018/V30/I6/557
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