Jin H, Zhao Y, Zhang X, Wang B, Liu P
Department of Epidemiology and Health Statistics,School of Public Health,Southeast University,Nanjing,China.
Key Laboratory of Environmental Medicine Engineering,Ministry of Education,School of Public Health,Southeast University,Nanjing,China.
Epidemiol Infect. 2016 Jul;144(10):2098-106. doi: 10.1017/S0950268816000418. Epub 2016 Mar 4.
It is of great concern that pregnant women with acute viral hepatitis (AVH) type E have serious consequences. This study aimed to estimate the case-fatality risk (CFR) and potential risk factors of pregnant women with AVH type E. We searched the PubMed, EMBASE, and Web of Science databases for studies containing data on CFR in pregnancy with AVH type E. A pooled estimate of CFR was calculated using a random-effects model. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression. We identified 47 eligible studies with a total African and Asian population of 3968 individuals. The pooled CFRs of maternal and fetal outcomes were 20·8% [95% confidence interval (CI) 16·6-25·3] and 34·2% (95% CI 26·0-43·0), respectively. Compared with these, the pooled CFR was highest (61·2%) in women with fulminant hepatic failure (FHF). Community-based surveys had lower pooled CFR (12·2%, 95% CI 9·2-15·6) and heterogeneity (25·8%, 95% CI 20·1-32·0) than hospital-based surveys. Univariate analysis showed that hospital-based surveying (P = 0·007), and patients in the third trimester of pregnancy or with FHF (P < 0·05), were significantly associated with CFR. Intrauterine fetal mortality (27·0%) was statistically higher than neonatal mortality (3·9%). Control measures for HEV infection would reduce feto-maternal mortality in Asia and Africa.
戊型急性病毒性肝炎（AVH）孕妇会产生严重后果，这令人深感担忧。本研究旨在评估戊型AVH孕妇的病死率（CFR）及潜在风险因素。我们在PubMed、EMBASE和Web of Science数据库中检索了包含戊型AVH孕妇CFR数据的研究。采用随机效应模型计算CFR的合并估计值。通过亚组分析、敏感性分析和Meta回归探索异质性的潜在来源。我们确定了47项符合条件的研究，非洲和亚洲总人口为3968人。孕产妇和胎儿结局的合并CFR分别为20.8%[95%置信区间（CI）16.6 - 25.3]和34.2%（95%CI 26.0 - 43.0）。相比之下，暴发性肝衰竭（FHF）女性的合并CFR最高（61.2%）。基于社区的调查的合并CFR（12.2%，95%CI 9.2 - 15.6）和异质性（25.8%，95%CI 20.1 - 32.0）低于基于医院的调查。单因素分析表明，基于医院的调查（P = 0.007）以及妊娠晚期或患有FHF的患者（P < 0.05）与CFR显著相关。宫内胎儿死亡率（27.0%）在统计学上高于新生儿死亡率（3.9%）。戊型肝炎病毒（HEV）感染的控制措施将降低亚洲和非洲的母婴死亡率。
