■缺乏关于查加斯病(ChD)临床表现的患病率的最新估计,因此,我们旨在评估血清阳性成人中临床形式的ChD的患病率,汇集可用数据。
■在Medline进行了系统评价,Embase,BibliotecaVirtualemSaúde和Cochrane数据库寻找1990年至2023年8月发表的研究,该研究调查了血清阳性成年人中ChD临床形式的患病率,包括:(i)不确定阶段,(ii)慢性查加斯心肌病(CCM),(iii)消化和(iv)混合(CCM+消化)形式。使用随机效应模型计算集合估计值和95%置信区间(CI)。使用Leboeuf-Yde和Lauritsen工具评估研究质量和偏倚风险。用I2统计量评估异质性。该研究在PROSPERO数据库(CRD42022354237)中注册。
■选择了1246篇文章进行筛选,最终分析包括73项研究(17,132例患者,44%的男性)。大多数研究是在门诊患者中进行的(n=50),其次是基于人群的研究(n=15)。ChD临床形式的合并患病率为:不确定的42.6%(95%CI:36.9-48.6),CCM42.7%(95%CI:37.3-48.3),消化系统17.7%(95%CI:14.9-20.9),混合10.2%(95%CI:7.9-13.2)。在基于人群的研究中,CCM的患病率较低(31.2%,95%CI:24.4-38.9),不确定的更高(47.2%,95%CI:39.0-55.5)形式。在元回归中,年龄与不确定(β=-0.05,P<0.001)形式的患病率呈负相关,并与CCM(β=0.06,P<0.001)和消化(β=0.02,P<0.001)直接相关。异质性总体较高。
■与以前的出版物相比,我们的汇总估计显示,在ChD血清阳性患者中,CCM的患病率更高,但消化形式的速率相似。
■这项研究由世界心脏联合会资助,通过与诺华制药公司的研究合作。
UNASSIGNED: There is a lack of up-to-date estimates about the prevalence of Chagas disease (ChD) clinical presentations and, therefore, we aimed to assess the prevalence of clinical forms of ChD among seropositive adults, pooling available data.
UNASSIGNED: A systematic review was conducted in Medline, Embase, Biblioteca Virtual em Saúde and Cochrane databases looking for studies published from 1990 to August 2023, which investigated the prevalence of ChD clinical forms among seropositive adults, including: (i) indeterminate phase, (ii) chronic Chagas cardiomyopathy (CCM), (iii) digestive and (iv) mixed (CCM + digestive) forms. Pooled estimates and 95% confidence intervals (CI) were calculated using random-effects models. Studies quality and risk of bias was assessed with the Leboeuf-Yde and Lauritsen tool. Heterogeneity was assessed with the I2 statistic. The study was registered in the PROSPERO database (CRD42022354237).
UNASSIGNED: 1246 articles were selected for screening and 73 studies were included in the final analysis (17,132 patients, 44% men). Most studies were conducted with outpatients (n = 50), followed by population-based studies (n = 15). The pooled prevalence of the ChD clinical forms was: indeterminate 42.6% (95% CI: 36.9-48.6), CCM 42.7% (95% CI: 37.3-48.3), digestive 17.7% (95% CI: 14.9-20.9), and mixed 10.2% (95% CI: 7.9-13.2). In population-based studies, prevalence was lower for CCM (31.2%, 95% CI: 24.4-38.9) and higher for indeterminate (47.2%, 95% CI: 39.0-55.5) form. In meta-regression, age was inversely associated with the prevalence of indeterminate (β = -0.05, P < 0.001) form, and directly associated with CCM (β = 0.06, P < 0.001) and digestive (β = 0.02, P < 0.001) forms. Heterogeneity was overall high.
UNASSIGNED: Compared to previous publications, our pooled estimates show a higher prevalence of CCM among ChD seropositive patients, but similar rates of the digestive form.
UNASSIGNED: This study was funded by the World Heart Federation, through a research collaboration with Novartis Pharma AG.