Zhang Ruizhong, Goto Taichiro, Zhang Xiaowei
Changchun Children's Hospital, Changchun, China.
Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan.
Transl Pediatr. 2025 Apr 30;14(4):671-682. doi: 10.21037/tp-2024-627. Epub 2025 Apr 22.
Human adenoviruses (HAdVs) are one of the most prevalent viruses in pediatric outpatients worldwide. The correlation between different genotypes of HAdVs and disease severity requires further investigation. The aim of this meta-analysis was to determine the association among HAdV load, viral genotypic diversity, and respiratory disease severity in children.
We conducted subject-term searches in English language databases, including Web of Science, PubMed, American Medical Association (AMA), Cochrane Library, and European Society for Clinical Nutrition and Metabolism (ESPEN), in addition to a Chinese language database, China National Knowledge Infrastructure (CNKI). We assessed the quality of the literature and performed a meta-analysis using RevMan 5.3 and STATA version 15.1. The study indicators were HAdV load, viral type, and disease severity. We assessed effect sizes using odds ratio (OR), standard error, and diagnostic efficacy indicators. We also performed heterogeneity tests, sensitivity analyses, and publication and bias assessments.
We retrieved 12 papers on HAdV load, genotyping, and severity of respiratory disease in children. Four papers on viral load indicated that a high viral load was associated with an increased risk of severe pneumonia [combined OR =2.02; 95% confidence interval (CI): 1.64-2.47]. Six papers on B3 subtype viruses reported a combined sensitivity of 0.42 and specificity of 0.99. Eight publications on B7 subtype viruses reported a combined sensitivity of 0.71 and specificity of 0.97. The combined OR increased with sample size, but the association was not significant for the B3 subtype and was more significant for the B7 subtype. For severe pneumonia, the combined sensitivity of quantitative polymerase chain reaction (qPCR) was 0.20 for B3 (95% CI: 0.13-0.28) and 0.48 for B7 (95% CI: 0.43-0.53), while the combined specificity for B3 was 0.96 (95% CI: 0.95-0.97) and 0.92 for B7 (95% CI: 0.85-0.98), which were higher than those of other polymerase chain reaction (PCR) methods.
In children, we found a significant association among HAdV load, the B3 and B7 subtypes, and respiratory disease severity. qPCR showed high sensitivity and specificity for detecting the B3 and B7 virus subtypes, suggesting its suitability for clinical use. This study provides important insights into the role of HAdVs in childhood respiratory infections and may guide clinical diagnosis and therapeutic strategies.
人类腺病毒（HAdVs）是全球儿科门诊中最常见的病毒之一。不同基因型的HAdVs与疾病严重程度之间的相关性需要进一步研究。本荟萃分析的目的是确定儿童中HAdV载量、病毒基因型多样性与呼吸道疾病严重程度之间的关联。
我们除了在中国知网（CNKI）这个中文数据库中进行检索外，还在包括科学网、PubMed、美国医学协会（AMA）、Cochrane图书馆和欧洲临床营养与代谢学会（ESPEN）在内的英文数据库中进行主题词检索。我们评估了文献质量，并使用RevMan 5.3和STATA 15.1版本进行荟萃分析。研究指标为HAdV载量、病毒类型和疾病严重程度。我们使用比值比（OR）、标准误差和诊断效能指标评估效应大小。我们还进行了异质性检验、敏感性分析以及发表偏倚评估。
我们检索到12篇关于儿童HAdV载量、基因分型和呼吸道疾病严重程度的论文。4篇关于病毒载量的论文表明，高病毒载量与严重肺炎风险增加相关[合并OR = 2.02；95%置信区间（CI）：1.64 - 2.47]。6篇关于B3亚型病毒的论文报告的合并敏感性为0.42，特异性为0.99。8篇关于B7亚型病毒的论文报告的合并敏感性为0.71，特异性为0.97。合并OR随样本量增加，但B3亚型的关联不显著，B7亚型的关联更显著。对于严重肺炎，定量聚合酶链反应（qPCR）对B3的合并敏感性为0.20（95% CI：0.13 - 0.28），对B7为0.48（95% CI：0.43 - 0.53），而B3的合并特异性为0.96（95% CI：0.95 - 0.97），B7为0.92（95% CI：0.85 - 0.98），均高于其他聚合酶链反应（PCR）方法。
在儿童中，我们发现HAdV载量、B3和B7亚型与呼吸道疾病严重程度之间存在显著关联。qPCR对检测B3和B7病毒亚型显示出高敏感性和特异性，表明其适用于临床应用。本研究为HAdVs在儿童呼吸道感染中的作用提供了重要见解，并可能指导临床诊断和治疗策略。
