Zhao Yilin, Xu Xiaodan, Liu Gengxin, Yang Fang, Zhan Jianghua
Graduate College, Tianjin Medical University, Tianjin, China.
Department of General Surgery, Tianjin Children's Hospital, Tianjin, China.
Front Pediatr. 2021 Aug 18;9:710450. doi: 10.3389/fped.2021.710450. eCollection 2021.
The etiology of biliary atresia is unclear, but viral infection has been implicated. The aim of the current meta-analysis was to investigate relationships between cytomegalovirus (CMV) and the prognosis of biliary atresia. PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure database, and Wanfang Data electronic databases were searched for eligible studies. Each relevant text was thoroughly reviewed and examined, including related papers in their reference lists. A total of nine studies including 784 patients were included in the analysis. Biliary atresia patients with CMV exhibited significantly lower jaundice clearance (odds ratio: 0.46, < 0.0001; = 15%, = 0.31). There were no significant differences in the rates of cholangitis or native liver survival. CMV-pp65-positive biliary atresia patients had a significantly lower rate of jaundice clearance (odds ratio: 5.87, = 0.003; = 0%, = 0.71) and a significantly higher rate of cholangitis (odds ratio: 0.21, = 0.01; = 0%, = 0.43) than CMV antibody-positive biliary atresia patients. Biliary atresia patients who were also infected with CMV had a poorer prognosis, particularly with respect to jaundice clearance. CMV status may influence the prognosis of biliary atresia. Clinicians should be able to routinely identify the subset of biliary atresia patients who are also CMV-positive, in order to improve native liver survival.
胆道闭锁的病因尚不清楚，但病毒感染被认为与之有关。本荟萃分析的目的是研究巨细胞病毒（CMV）与胆道闭锁预后之间的关系。检索了PubMed、Embase、Cochrane图书馆、中国知网数据库和万方数据电子数据库以查找符合条件的研究。对每一篇相关文献进行了全面的审查和检查，包括其参考文献列表中的相关论文。共有9项研究（包括784例患者）纳入分析。CMV感染的胆道闭锁患者黄疸清除率显著较低（比值比：0.46，<0.0001；I² = 15%，P = 0.31）。胆管炎发生率或自体肝存活率无显著差异。与CMV抗体阳性的胆道闭锁患者相比，CMV-pp65阳性的胆道闭锁患者黄疸清除率显著较低（比值比：5.87，P = 0.003；I² = 0%，P = 0.71），胆管炎发生率显著较高（比值比：0.21，P = 0.01；I² = 0%，P = 0.43）。同时感染CMV的胆道闭锁患者预后较差，尤其是在黄疸清除方面。CMV状态可能影响胆道闭锁的预后。临床医生应能够常规识别出同时为CMV阳性的胆道闭锁患者亚组，以提高自体肝存活率。
