Shan Jiayi, Huang Baoyi, Xin Yijun, Li Ran, Zhang Xiaoling, Xu Hua
Department of Pediatrics of Traditional Chinese Medicine, Guangzhou Women and Children's Medical Center, Guangzhou, China.
The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.
PLoS One. 2024 Dec 5;19(12):e0311772. doi: 10.1371/journal.pone.0311772. eCollection 2024.
The World Health Organization has issued a global alert on Acute Severe Hepatitis of Unknown Aetiology (AS-HEP-UA) since 23 April 2022,and there was still uncertainty regarding the association of AS-HEP-UA with SARS-CoV-2 as well as adenovirus. This study aimed to summarize the infection of SARS-CoV-2 and co-infections with adenovirus, as well as clinical features and outcomes in patients with AS-HEP-UA. PubMed, Embase, Web of Science, and the Cochrane Library were searched from 1 October 2021 to 8 December 2022 for studies about patients with AS-HEP-UA. This study was registered in the PROSPERO database (CRD42023385056). We has included 14 eligible articles. The main clinical features of AS-HEP-UA were jaundice (65%) and vomiting (59%), while other clinical features included diarrhea (45%), abdominal pain (37%), and fever (31%), roughly 10% of the children required liver transplantation. The overall positivity rate for SARS-CoV-2 was 21.6% (95% CI: 0.126-0.319), with 25.5% (95% CI: 0.161-0.358) for previous infections. The positivity rate for adenovirus infection was 58.6% (95% CI:0.429-0.736) while co-infection with SARS-CoV-2 was 17.5% (95% CI: 0.049-0.342). Moreover, we found that the positive rate of SARS-CoV-2 for this hepatitis outbreak was correlated with region by subgroup analysis. In conclusion, the positive rate of adenovirus was higher than SARS-CoV-2, and the relationship between AS-Hep-UA and COVID-19 is not significant. However, it cannot be excluded that the COVID-19 epidemic is an indirect causative agent of AS-Hep-UA, which requires a larger cohort of AS-Hep-UA patients to uncover additional findings.
自2022年4月23日起，世界卫生组织就不明病因的急性重症肝炎（AS-HEP-UA）发布了全球警报，AS-HEP-UA与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）以及腺病毒之间的关联仍不明确。本研究旨在总结SARS-CoV-2感染及腺病毒合并感染情况，以及AS-HEP-UA患者的临床特征和预后。于2021年10月1日至2022年12月8日在PubMed、Embase、科学网和考克兰图书馆中检索关于AS-HEP-UA患者的研究。本研究已在国际前瞻性系统评价注册库（PROSPERO）数据库中注册（注册号：CRD42023385056）。我们纳入了14篇符合条件的文章。AS-HEP-UA的主要临床特征为黄疸（65%）和呕吐（59%），其他临床特征包括腹泻（45%）、腹痛（37%）和发热（31%），约10%的儿童需要进行肝移植。SARS-CoV-2的总体阳性率为21.6%（95%置信区间：0.126 - 0.319），既往感染的阳性率为25.5%（95%置信区间：0.161 - 0.358）。腺病毒感染的阳性率为58.6%（95%置信区间：0.429 - 0.736），与SARS-CoV-2合并感染的阳性率为17.5%（95%置信区间：0.049 - 0.342）。此外，通过亚组分析我们发现，此次肝炎暴发中SARS-CoV-2的阳性率与地区相关。总之，腺病毒的阳性率高于SARS-CoV-2，且AS-Hep-UA与新型冠状病毒肺炎（COVID-19）之间的关系并不显著。然而，不能排除COVID-19疫情是AS-Hep-UA的间接致病因素，这需要更大规模队列的AS-Hep-UA患者来发现更多结果。
