背景:戊型肝炎可能发展为HEV相关的急性肝衰竭(HEV-ALF)。东亚和南亚承受着巨大的HEV感染负担,孟加拉国,中国,印度面临着该地区最严重的威胁。因此,我们进行了系统评价和荟萃分析,以评估这三个高危国家的HEV-ALF负担.
方法:利用PubMed进行了系统的文献检索,Cochrane图书馆,Medline,Embase,和WebofScience数据库。英文或中文研究报告了孟加拉国HEV-ALF负担的数据,包括中国和印度。结果与使用R软件的荟萃分析汇总。估计值是用随机效应模型计算的,并进行亚组分析和敏感性分析以解决异质性。进行Egger测试和Begg测试以评估发表偏倚。
结果:本研究共纳入20项符合条件的研究。病毒相关急性肝衰竭的合并HEV归因比例估计为40.0%(95%CI:0.28-0.52),30.0%(95%CI:0.18-0.44),61.0%(95%CI:0.49-0.72)在印度非孕妇中,中国和孟加拉国,在印度怀孕的女性中,为71.0%(95%CI:0.62-0.79)。在印度和中国,非妊娠HEV感染参与者的合并患病率分别为28.0%(95%CI:0.20-0.37)和10.0%(95%CI:0.01-0.28)。印度妊娠女性合并HEV感染的比例为34.0%(95%CI:0.27-0.42)。在印度非孕妇和孕妇中,HEV-ALF的总死亡率估计为32.0%(95%CI:0.23-0.42)和64.0%(95%CI:0.50-0.77)。中国非妊娠参与者为23.0%(95%CI:0.14-0.34)。
结论:孟加拉国HEV-ALF的负担,中国,尽管地理和人口异质性,印度也是不可忽视的。预防HEV感染和早期识别HEV-ALF具有重要意义,特别是在高风险国家和人群中。
背景:PROSPERO注册ID为CRD42022382101。
Hepatitis E can potentially progress to HEV-related acute liver failure (HEV-ALF). East and South Asia bear a substantial burden of HEV infection, with Bangladesh, China, and India facing the most severe threat in this region. Therefore, we conducted a systematic
review and meta-analysis to evaluate the burden of HEV-ALF in these three high-risk countries.
A systematic literature search was performed utilizing PubMed, the Cochrane Library, Medline, Embase, and Web of Science databases. Studies in English or Chinese that reported data on the burden of HEV-ALF in Bangladesh, China and India were included. Outcomes were pooled with meta-analysis utilizing R software. Estimates were calculated with random-effects models, and subgroup analysis and sensitivity analysis were conducted to address heterogeneity. Egger\'s test and Begg\'s test were performed to assess publication bias.
A total of 20 eligible studies were included in this study. The pooled HEV-attributable proportion of viral-related acute liver failure was estimated to be 40.0% (95% CI: 0.28-0.52), 30.0% (95% CI: 0.18-0.44), and 61.0% (95% CI: 0.49-0.72) among non-pregnant individuals in India, China and Bangladesh, while in Indian pregnant females, it was 71.0% (95% CI: 0.62-0.79). The combined prevalence among non-pregnant HEV-infected participants was 28.0% (95% CI: 0.20-0.37) and 10.0% (95% CI: 0.01-0.28) in India and China, and it was 34.0% (95% CI: 0.27-0.42) in Indian pregnant females with HEV infection. The overall mortality of HEV-ALF was estimated to be 32.0% (95% CI: 0.23-0.42) and 64.0% (95% CI: 0.50-0.77) among the non-pregnant and the pregnant participants in India, and it was 23.0% (95% CI: 0.14-0.34) in Chinese non-pregnant participants.
The burden of HEV-ALF in Bangladesh, China, and India is non-negligible despite geographic and population heterogeneity. The prevention of HEV infection and early recognition of HEV-ALF are of great significance, especially in high-risk countries and populations.
PROSPERO registration ID is CRD42022382101.