献血者经皮穿刺治疗后存在输血传播感染的风险吗？一项系统评价和荟萃分析。

Is there a risk of transfusion-transmissible infections after percutaneous needle treatments in blood donors? A systematic review and meta-analysis.

作者信息

Van Remoortel Hans, Moorkens Dorien, Avau Bert, Compernolle Veerle, Vandekerckhove Philippe, De Buck Emmy

机构信息

Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.

Cochrane Belgium, Belgian Centre for Evidence-Based Medicine (Cebam), Leuven, Belgium.

出版信息

Vox Sang. 2019 May;114(4):297-309. doi: 10.1111/vox.12780. Epub 2019 Apr 10.

DOI:10.1111/vox.12780

PMID:30972765

Abstract

BACKGROUND AND OBJECTIVES

The donor medical questionnaire identifies a blood donor's history of known blood safety risks. Current Australian, Canadian, European and USA legislation temporarily defers blood donors who received different percutaneous needle treatments (i.e. tattooing, acupuncture and piercing) from blood donation. This systematic review aimed to scientifically underpin these deferrals by identifying the best available evidence on the association between percutaneous needle treatments and the risk of transfusion-transmissible infections (TTIs).

MATERIALS AND METHODS

Studies from three databases investigating the link between percutaneous needle treatments and TTIs (HBV, HCV and HIV infection) in blood donors were retained and assessed on eligibility by two reviewers independently. The association between percutaneous needle treatments and TTIs was expressed by conducting meta-analyses and calculating pooled effect measures (odds ratios (ORs) and 95% CIs). The GRADE methodology (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the quality of evidence.

RESULTS

We identified 1242 references and finally included 21 observational studies. Twenty studies assessed the link between percutaneous needle treatments and HCV infection and found that blood donors receiving these treatments had an increased risk of HCV infection (tattooing: pooled OR 5·28, 95% CI [4·33, 6·44], P < 0·00001 (low-quality evidence); acupuncture: pooled OR 1·56, 95% CI [1·17, 2·08], P = 0·03 (very low-quality evidence); and piercing: pooled OR 3·25, 95% CI [1·68, 6·30], P = 0·0005 (low-quality evidence)).

CONCLUSION

Percutaneous needle treatments may be associated with an increased HCV infection risk. Further high-quality studies are required to formulate stronger evidence-based recommendations on percutaneous needle treatments as a blood donor deferral criterion.

摘要

背景与目的

献血者医学调查问卷可识别献血者已知的血液安全风险史。澳大利亚、加拿大、欧洲和美国现行立法暂时推迟接受不同经皮针刺治疗（即纹身、针灸和穿孔）的献血者献血。本系统评价旨在通过确定关于经皮针刺治疗与输血传播感染（TTIs）风险之间关联的最佳现有证据，为这些推迟献血的措施提供科学依据。

材料与方法

保留来自三个数据库的研究，这些研究调查了献血者经皮针刺治疗与TTIs（乙肝病毒、丙肝病毒和艾滋病毒感染）之间的联系，并由两名评审员独立评估其是否符合纳入标准。经皮针刺治疗与TTIs之间的关联通过进行荟萃分析和计算合并效应量（比值比（ORs）和95%置信区间）来表示。采用GRADE方法（推荐分级、评估、制定与评价）评估证据质量。

结果

我们识别出1242篇参考文献，最终纳入21项观察性研究。20项研究评估了经皮针刺治疗与丙肝病毒感染之间的联系，发现接受这些治疗的献血者感染丙肝病毒的风险增加（纹身：合并OR 5.28，95%置信区间[4.33, 6.44]，P < 0.00001（低质量证据）；针灸：合并OR 1.56，95%置信区间[1.17, 2.08]，P = 0.03（极低质量证据）；穿孔：合并OR 3.25，95%置信区间[1.68, 6.30]，P = 0.0005（低质量证据））。