背景:Opistorchiasis和华支睾吸虫病,由蛇形肌和华支睾吸虫引起,分别,是大湄公河次区域(GMS)中重要但被忽视的食源性吸虫酶。尽管在过去的几十年中,这些人类肝吸虫在该地区的患病率有报道,这些数据缺乏全面和系统的整合。因此,我们旨在进行全面的系统评价和荟萃分析,以综合和分析过去30年GMS中O.viverrini和C.sinensis的时间趋势患病率估计值。
方法:这项研究通过全面搜索PubMed上发表的文章进行了系统的综述,EMBASE,Scopus,Cochrane和泰国期刊在线数据库,直到2023年初。通过随机效应荟萃分析分析了O.viverrini和C.sinensis感染的合并患病率,使用荟萃回归分析来量化与研究特征的关联。进行亚组分析,每当有比较数据时,评估每个GMS国家O.viverrini和C.sinensis感染的风险。使用Q统计量评估研究之间的异质性,并使用I2指数进行量化。
结果:在总共2997篇文章中,包括218个数据集和751,108个参与者的155篇文章被纳入审查。O.viverrini的GMS患病率为21.11%[45,083/260,237;95%置信区间(CI):17.74-24.47%]。汇总的患病率估计值在老挝得到了很高的观察(34.06%,95%CI:26.85-41.26%),其次是泰国(18.19%,95%CI:13.86-22.51%),和柬埔寨(10.48%,95%CI:5.52-15.45%)。缅甸和越南用于计算的数据来源有限。华支睾吸虫在GMS中的感染率为25.33%(95%CI:18.32-32.34%),广西,中国,患病率最高,为26.89%(95%CI:18.34-35.43%),而越南的患病率为20.30%(95%CI:9.13-31.47%)。O.viverrini患病率随着时间的推移显着下降,而中国和越南的C.sinensis感染似乎在一段时间内保持稳定。
结论:这项综合研究,从迄今为止最大的数据集中绘制,提供了大湄公河次区域人类肝吸虫的深入系统的患病率评价。它强调了系统监测的必要性,数据收集,并对这些传染病的贫困实施干预和控制措施。
BACKGROUND: Opisthorchiasis and clonorchiasis, caused by Opisthorchis viverrini and Clonorchis sinensis, respectively, are significant yet neglected foodborne trematodiases in the Great Mekong Subregion (GMS). Despite the reporting of the prevalence of these
human liver flukes in the region over the past decades, there has been a lack of a comprehensive and systematic consolidation of this data. Therefore, we aimed to conduct a thorough systematic
review and meta-analysis to synthesize and analyze time-trend prevalence estimates of both O. viverrini and C. sinensis across the GMS for the past 30 years.
METHODS: This study undertakes a systematic
review using a comprehensive search for published articles in PubMed, EMBASE, Scopus, Cochrane and Thai Journal Online databases until early 2023. The pooled prevalence of O. viverrini and C. sinensis infection was analyzed through a random-effects meta-analysis, with meta-regression analysis used to quantify associations with study characteristics. Sub-group analysis was conducted, whenever comparison data were available, to assess the risk of O. viverrini and C. sinensis infection in each GMS country. Heterogeneity among studies was assessed using the Q statistic and quantified by using the I 2 Index.
RESULTS: From a total of 2997 articles, 155 articles comprising 218 datasets and 751,108 participants were included for
review. The GMS prevalence of O. viverrini was 21.11% [45,083/260,237; 95% confidence interval (CI): 17.74-24.47%]. Pooled prevalence estimates were highly observed in Laos (34.06%, 95% CI: 26.85-41.26%), followed by Thailand (18.19%, 95% CI: 13.86-22.51%), and Cambodia (10.48%, 95% CI: 5.52-15.45%). Myanmar and Vietnam had limited data sources for calculation. Clonorchis sinensis infection in GMS was 25.33% (95% CI: 18.32-32.34%), with Guangxi, China, exhibiting the highest prevalence rates at 26.89% (95% CI: 18.34-35.43%), while Vietnam had a prevalence rate of 20.30% (95% CI: 9.13-31.47%). O. viverrini prevalence decreased significantly over time, whereas C. sinensis infection appeared to be stable consistently over time in both China and Vietnam.
CONCLUSIONS: This comprehensive study, drawing from the largest datasets to date, offers an in-depth systematic prevalence review of
human liver flukes in the Greater Mekong Subregion. It underscores the imperative for systematic surveillance, data collection, and the implementation of intervention and control measures for these infectious diseases of poverty.