中国急性戊型肝炎重症化危险因素的Meta分析

Meta-Analysis of Severe Risk Factors for Acute Hepatitis E in China

摘要: 目的：评估中国戊型肝炎病毒感染与肝衰竭的关联，并探讨其重症化的临床特点及影响因素。方法：检索PubMed、Web of Science、Embase、中国知网(CNKI)、万方等数据库，筛选2012年至2023年间相关文献，通过纳排标准及用纽卡斯尔–渥太华量表进行文献的筛选及质量评价，并采用RevMan5.4软件进行Meta分析。结果：共纳入21项研究，包含5663例急性戊型肝炎患者，其中853例(15.06%)进展为重症。老年(OR = 2.62, 95% CI = 1.98~3.47)、男性(OR = 2.05, 95% CI = 1.06~3.98)、合并基础肝病即重叠感染(OR = 0.29, 95% CI = 0.21~0.42)、糖尿病(OR = 2.11, 95% CI = 1.42~3.11)的患者更易发生肝衰竭。重叠感染者中，重症化的主要危险因素按照其关联性由强到弱依次为：肝硬化(OR = 5.76, 95% CI = 3.61~9.19)、自身免疫性肝病(OR = 4.01, 95% CI = 1.35~11.92)、HBV感染(OR = 3.95, 95% CI = 2.21~7.04)、脂肪性肝病(OR = 1.13, 95% CI = 0.63~2.03)、酒精性肝病(OR = 1.07, 95% CI = 0.57~2.01)。结论：在中国，老年、男性、重叠感染以及糖尿病等是急性戊型肝炎重症化的主要影响因素。而伴有肝硬化的重叠感染者，重症化的风险显著增加。

Abstract: Objective: To assess the association between Hepatitis E virus infection and hepatic failure in China, as well as to investigate the clinical characteristics and risk factors for severity. Methods: A systematic literature search was conducted across databases including PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wan Fang, focusing on studies published between 2012 and 2023. Studies were selected based on predefined inclusion and exclusion criteria, and the quality of the included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software. Results: A total of 21 studies involving 5663 patients with acute HEV infection, among which 853 cases (15.06%) progressed to severe hepatitis. Patients with elderly (OR = 2.62, 95% CI = 1.98~3.47), male (OR = 2.05, 95% CI = 1.06~3.98), underlying liver disease or co-infections (OR = 0.29, 95% CI = 0.21~0.42), and diabetes mellitus (OR = 2.11, 95% CI = 1.42~3.11), are at an increased risk of hepatic failure. For patients with co-infection, the main risk factors for severe progression, ranked from strongest to weakest association, were liver cirrhosis (OR = 5.76, 95% CI = 3.61~9.19), autoimmune liver disease (OR = 4.01, 95% CI = 1.35~11.92), HBV infection (OR = 3.95, 95% CI = 2.21~7.04), fatty liver disease (OR = 1.13, 95% CI = 0.63~2.03), and alcoholic liver disease (OR = 1.07, 95% CI = 0.57~2.01). Conclusion: In China, older age, male gender, superinfection, and diabetes mellitus are significant risk factors for the severe progression of acute HEV infection. Notably, patients with concurrent liver cirrhosis face a markedly increased risk of severe outcomes.