肥胖对感染和脓毒症临床前动物模型结局的影响：系统评价和荟萃分析。
The Effects of Obesity on Outcome in Preclinical Animal Models of Infection and Sepsis: A Systematic Review and Meta-Analysis.
机构信息
Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
National Institutes of Health Library, National Institutes of Health, Bethesda, MD 20892, USA.
出版信息
J Obes. 2020 Feb 17;2020:1508764. doi: 10.1155/2020/1508764. eCollection 2020.
BACKGROUND
Clinical studies suggest obesity paradoxically increases survival during bacterial infection and sepsis but decreases it with influenza, but these studies are observational. By contrast, animal studies of obesity in infection can prospectively compare obese nonobese controls. We performed a systematic review and meta-analysis of animal investigations to further examine obesity's survival effect in infection and sepsis.
METHODS
Databases were searched for studies comparing survival in obese nonobese controls. We performed a systematic review and meta-analysis of animal investigations to further examine obesity's survival effect in infection and sepsis. . Databases were searched for studies comparing survival in obese nonobese animals following bacteria, lipopolysaccharide, or influenza virus challenges.
RESULTS
Twenty-one studies (761 obese and 603 control animals) met the inclusion criteria. Obesity reduced survival in 19 studies (11 significantly) and the odds ratio (95% CI) of survival (0.21(0.13, 0.35); = 64%, < 0.01 < 0.01 < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies ( = 6 studies, 0.21(0.13, 0.34); = 64%, < 0.01 < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies ( = 6 studies, 0.21(0.13, 0.34); = 64%, < 0.01 < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies ( = 6 studies, 0.21(0.13, 0.34); = 64%, < 0.01 < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies ( = 6 studies, 0.21(0.13, 0.34); = 64%, < 0.01 < 0.01 < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies ( = 6 studies, 0.21(0.13, 0.34); = 31%, =0.20 and = 5, 0.22(0.13, 0.36); = 0%, =0.59, respectively), (2) not significantly with cecal ligation and puncture ( = 4, 0.72(0.08, 6.23); = 75%, < 0.01), and (3) significantly with influenza but with high heterogeneity ( = 6, 0.12(0.04, 0.34); = 73%, < 0.01). Obesity's survival effects did not differ significantly comparing the four challenge types (=0.49). Animal models did not include antimicrobials or glycemic control and study quality was low.
CONCLUSIONS
Preclinical and clinical studies together emphasize the need for prospective studies in patients accurately assessing obesity's impact on survival during severe infection.
背景
临床研究表明，肥胖在细菌感染和败血症中增加了患者的存活率，但在流感感染中却降低了存活率，但这些研究都是观察性的。相比之下，动物感染肥胖研究可以前瞻性地比较肥胖和非肥胖对照组。我们对动物感染肥胖的研究进行了系统回顾和荟萃分析，以进一步研究肥胖对感染和败血症的生存影响。
方法
检索数据库以比较肥胖和非肥胖动物在细菌、脂多糖或流感病毒挑战后的存活率。我们对动物感染肥胖的研究进行了系统回顾和荟萃分析，以进一步研究肥胖对感染和败血症的生存影响。检索数据库以比较肥胖和非肥胖动物在细菌、脂多糖或流感病毒挑战后的存活率。
结果
21 项研究（761 例肥胖动物和 603 例对照动物）符合纳入标准。19 项研究（11 项显著）表明肥胖降低了存活率，且肥胖动物的存活比值比（95%CI）为 0.21（0.13，0.35）；（）=64%，<0.01<0.01<0.01），但存在高度异质性。肥胖在单一致病菌和脂多糖挑战的研究中一致降低了存活率（=6 项研究，0.21（0.13，0.34）；（）=64%，<0.01<0.01），但存在高度异质性。肥胖在单一致病菌和脂多糖挑战的研究中一致降低了存活率（=6 项研究，0.21（0.13，0.34）；（）=64%，<0.01<0.01），但存在高度异质性。肥胖在单一致病菌和脂多糖挑战的研究中一致降低了存活率（=6 项研究，0.21（0.13，0.34）；（）=64%，<0.01<0.01），但存在高度异质性。肥胖在单一致病菌和脂多糖挑战的研究中一致降低了存活率（=6 项研究，0.21（0.13，0.34）；（）=64%，<0.01<0.01），但存在高度异质性。肥胖在单一致病菌和脂多糖挑战的研究中一致降低了存活率（=6 项研究，0.21（0.13，0.34）；（）=64%，<0.01<0.01），但存在高度异质性。肥胖在单一致病菌和脂多糖挑战的研究中一致降低了存活率（=6 项研究，0.21（0.13，0.34）；（）=64%，<0.01<0.01），但存在高度异质性。肥胖在单一致病菌和脂多糖挑战的研究中一致降低了存活率（=6 项研究，0.21（0.13，0.34）；（）=64%，<0.01<0.01），但存在高度异质性。肥胖在单一致病菌和脂多糖挑战的研究中一致降低了存活率（=6 项研究，0.21（0.13，0.34）；（）=64%，<0.01<0.01），但存在高度异质性。肥胖在单一致病菌和脂多糖挑战的研究中一致降低了存活率（=6 项研究，0.21（0.13，0.34）；（）=64%，<0.01<0.01），但存在高度异质性。肥胖在流感病毒感染中显著降低了存活率，但存在高度异质性（=6 项研究，0.12（0.04，0.34）；（）=73%，<0.01）。
结论
临床前和临床研究共同强调需要前瞻性研究准确评估肥胖对严重感染期间的存活率的影响。
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