Hodson E M, Jones C A, Strippoli G F M, Webster A C, Craig J C
Children's Hospital at Westmead, Centre for Kidney Research, Locked Bag 4001, Westmead, NSW, Australia, 2145.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD005129. doi: 10.1002/14651858.CD005129.pub2.
Cytomegalovirus (CMV) is the most common virus causing disease and death in solid organ transplant recipients during the first six months post-transplant. Previous systematic reviews have demonstrated the efficacy of antiviral medications used prophylactically or pre-emptively in preventing CMV disease. In this review the efficacy of older agents (immunoglobulins (IgG), anti CMV vaccines and interferon) are examined.
To assess the benefits and harms of IgG, anti CMV vaccines or interferon for preventing symptomatic CMV disease in solid organ transplant recipients.
We searched the Cochrane Renal Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library), MEDLINE, EMBASE, reference lists and abstracts from conference proceedings without language restriction. Date of last search: December 2005
Randomised and quasi-randomised controlled trials comparing IgG, anti CMV vaccine or interferon with placebo or no treatment, IgG alone or combined with antiviral medications with antiviral medications or IgG alone in recipients of any solid organ transplant.
Two of four authors independently assessed trial quality and extracted data from each trial. Statistical analyses were performed using the random effects model and results expressed as relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI).
Thirty seven trials (2185 participants) were included in this review. There was no significant difference in the risk for CMV disease (16 trials, 770 patients: RR 0.80, 95% CI 0.61 to 1.05), CMV infection (14 trials, 775 patients: RR 0.94, 95% CI 0.80 to 1.10) or all-cause mortality (8 trials, 502 patients: RR 0.57, 95% CI 0.32 to 1.03) with IgG compared with placebo/no treatment. However IgG significantly reduced the risk of death from CMV disease (6 trials, 346 patients: RR 0.33, 95% CI 0.14 to 0.80). There was no difference in the risk for CMV disease (4 trials, 298 patients: RR 1.17, 95% CI 0.74 to 1.86), CMV infection (4 trials, 298 patients: RR 1.16, 95% CI 0.89 to 1.52) or all-cause mortality (2 trials, 217 patients: RR 0.92, 95% CI 0.37 to 2.29) between antiviral medication combined with IgG and antiviral medication alone. There was no significant difference in the risk of CMV disease with anti CMV vaccine or interferon compared with placebo or no treatment.
AUTHORS' CONCLUSIONS: Currently there are no indications for IgG in the prophylaxis of CMV disease in recipients of solid organ transplants.
巨细胞病毒（CMV）是实体器官移植受者在移植后前六个月导致疾病和死亡的最常见病毒。以往的系统评价已证明预防性或抢先使用抗病毒药物在预防CMV疾病方面的疗效。本综述对较老的药物（免疫球蛋白（IgG）、抗CMV疫苗和干扰素）的疗效进行了研究。
评估IgG、抗CMV疫苗或干扰素在预防实体器官移植受者出现症状性CMV疾病方面的益处和危害。
我们检索了Cochrane肾脏组专业注册库、Cochrane对照试验中心注册库（CENTRAL，Cochrane图书馆）、MEDLINE、EMBASE、参考文献列表以及会议论文摘要，无语言限制。最后检索日期：2005年12月
将IgG、抗CMV疫苗或干扰素与安慰剂或不治疗、单独使用IgG或与抗病毒药物联合使用抗病毒药物或单独使用IgG进行比较的随机和半随机对照试验，涉及任何实体器官移植受者。
四位作者中的两位独立评估试验质量并从每个试验中提取数据。采用随机效应模型进行统计分析，结果以二分类结局的相对风险（RR）及95%置信区间（CI）表示。
本综述纳入了37项试验（2185名参与者）。与安慰剂/不治疗相比，使用IgG时，CMV疾病风险（16项试验，770例患者：RR 0.80，95%CI 0.61至1.05）、CMV感染风险（14项试验，775例患者：RR 0.94，95%CI 0.80至1.10）或全因死亡率（8项试验，502例患者：RR 0.57，95%CI 0.32至1.03）无显著差异。然而，IgG显著降低了CMV疾病导致的死亡风险（6项试验，346例患者：RR 0.33，95%CI 0.14至0.80）。抗病毒药物联合IgG与单独使用抗病毒药物相比，CMV疾病风险（4项试验，298例患者：RR 1.17，95%CI 0.74至1.86）、CMV感染风险（4项试验，298例患者：RR 1.16，95%CI 0.89至
