肿瘤坏死因子-α作为严重疟疾预后生物标志物的系统评价和荟萃分析。

Tumour necrosis factor-α as a prognostic biomarker of severe malaria: a systematic review and meta-analysis.

机构信息

Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

Department of Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.

出版信息

J Travel Med. 2022 Jul 14;29(4). doi: 10.1093/jtm/taac053.

DOI:10.1093/jtm/taac053

PMID:35467747

Abstract

BACKGROUND

Tumour necrosis factor-alpha (TNF-α) levels are reportedly altered during malaria. In this systematic review and meta-analysis, we aimed to collect and compare data on TNF-α levels between patients with malaria of varying severity and healthy asymptomatic positive controls.

METHODS

We searched PubMed, Scopus and Web of Science for studies that reported TNF-α levels in malaria cases of different severity and healthy asymptomatic positive controls using a combination of search terms. The quality of the included studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. To compare the TNF-α levels among fatal cases, severe cases, uncomplicated cases and healthy asymptomatic positive controls, we applied the random-effects model that assumed the existence of variations between studies. The effect estimate was pooled mean difference (MD) with a 95% confidence interval (CI).

RESULTS

From 1694 studies, we included 31 studies that met our eligibility criteria for systematic review and meta-analysis. Patients with severe malaria showed higher mean TNF-α levels than those with uncomplicated malaria (P < 0.001, pooled MD = 79.02 pg/ml, 95% CI: 63.68-94.35 pg/ml, I2: 99.5%, n = 26 studies). Furthermore, fatal cases had no difference in the mean TNF-α levels in comparison with survived cases (P = 0.055, pooled MD = 82.38 pg/ml, 95% CI: -1.93 to 166.69 pg/ml, I2: 99.54%, n = 5 studies). Finally, patients with uncomplicated malaria showed higher mean TNF-α levels than those with asymptomatic malaria (P < 0.001, pooled MD = 45.10 pg/ml, 95% CI: 18.45-71.76 pg/ml, I2: 97.09%, n = 5 studies).

CONCLUSION

This systematic review and meta-analysis confirmed the increase of TNF-α levels in patients with severe malaria. Therefore, TNF-α may be alternatively used as a prognostic biomarker of severe malaria.

TRIAL REGISTRATION

Not applicable.

摘要

背景

据报道，肿瘤坏死因子-α（TNF-α）水平在疟疾期间发生改变。在这项系统评价和荟萃分析中，我们旨在收集和比较不同严重程度疟疾患者与健康无症状阳性对照者之间 TNF-α 水平的数据。

方法

我们使用搜索词的组合，在 PubMed、Scopus 和 Web of Science 中搜索报道不同严重程度疟疾病例和健康无症状阳性对照者 TNF-α 水平的研究。使用观察性研究的强化报告标准检查表评估纳入研究的质量。为了比较致命病例、严重病例、无并发症病例和健康无症状阳性对照者之间的 TNF-α 水平，我们应用了随机效应模型，假设研究之间存在差异。效应估计值为合并均数差（MD）及其 95%置信区间（CI）。

结果

从 1694 项研究中，我们纳入了 31 项符合系统评价和荟萃分析纳入标准的研究。严重疟疾患者的平均 TNF-α 水平高于无并发症疟疾患者（P<0.001，合并 MD=79.02 pg/ml，95%CI：63.68-94.35 pg/ml，I2：99.5%，n=26 项研究）。此外，与存活病例相比，致命病例的平均 TNF-α 水平无差异（P=0.055，合并 MD=82.38 pg/ml，95%CI：-1.93 至 166.69 pg/ml，I2：99.54%，n=5 项研究）。最后，无并发症疟疾患者的平均 TNF-α 水平高于无症状疟疾患者（P<0.001，合并 MD=45.10 pg/ml，95%CI：18.45-71.76 pg/ml，I2：97.09%，n=5 项研究）。