腺病毒病：228 例病例报告的系统评价和荟萃分析。
Adenovirus diseases: a systematic review and meta-analysis of 228 case reports.
机构信息
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China.
出版信息
Infection. 2021 Feb;49(1):1-13. doi: 10.1007/s15010-020-01484-7. Epub 2020 Jul 27.
OBJECTIVE
The clinical characteristics of various adenovirus (ADV) infection are underexplored up till now. To investigate the risk factors, manifestation, current status of ADV species, treatment and prognosis of this disease.
METHODS
We performed a Pubmed and Embase systematic review for case report reporting the ADV infection to analyze the clinical characteristics of disease.
RESULTS
Initial database searched identified articles of which 168 (228 cases) were included in the final analysis. Previous solid organ transplantation [odds ratio (OR) = 3.45, 95% CI 1.31-9.08, P = 0.01], hematopoietic stem cell transplant (OR = 4.24, 95% CI 1.33-13.51, P = 0.01) and hematological malignancy (OR = 4.78, 95% CI 1.70-13.46, P = 0.01) were associated with increased risk of disseminated ADV infection. Use of corticosteroids (OR = 3.86, 95% CI 1.21-12.24, P = 0.02) was a significant risk factor for acquiring urinary tract infections. A total of six species (21 types) of ADV infection have been identified in 100/228 (43.9%) cases. ADV B was the most common species. ADV B species (26/60, 52.0% or 5/41, 12.2% P = 0.001) were more isolated in patients with ADV pneumonia. ADV C (13/15, 86.7% versus 35/86, 40.7% P = 0.001) species were more identified in patients with disseminated disease. The species associated with keratoconjunctivitis is only ADV D in our analysis. Urinary tract ADV infections were observed in ADV A/B/D species. Cidofovir (CDV) (82/228, 36.0%) remained the most commonly antiviral therapy in our cases, followed by ribavirin (15/228, 6.6%), ganciclovir (18/228, 7.9%), and brincidofovir (12/228, 5.3%). Brincidofovir was administered as salvage therapy in 10 cases. Death was reported in 81/228 (35.5%) patients. Mortality rate was higher among patients with gastrointestinal (GI) ADV infection (5/10, 50.0%), ADV pneumonia (20/45, 44.4%) and disseminated ADV infection (53/122, 43.4%).
CONCLUSION
Previous solid organ transplantation, hematopoietic stem cell transplant and hematological malignancy were risk factors for disseminated ADV infection. Use of corticosteroids was significant for urinary tract ADV infection. Different species correlated with different clinical manifestations of infection. Mortality rate was higher among patients with GI disease, pneumonia and disseminated disease. Our review clarified the current treatment of ADV infections, and more treatment required further investigation.
目的
目前腺病毒（ADV）感染的临床特征尚未得到充分研究。本研究旨在探讨ADV 感染的危险因素、临床表现、ADV 种属现状、治疗和预后。
方法
我们对 ADV 感染的病例报告进行了 Pubmed 和 Embase 系统评价，以分析疾病的临床特征。
结果
最初的数据库搜索确定了纳入最终分析的 168 篇（228 例）文章。先前的实体器官移植[比值比（OR）=3.45，95%置信区间（CI）1.31-9.08，P=0.01]、造血干细胞移植（OR=4.24，95%CI 1.33-13.51，P=0.01）和血液恶性肿瘤（OR=4.78，95%CI 1.70-13.46，P=0.01）与播散性 ADV 感染的风险增加相关。皮质类固醇的使用（OR=3.86，95%CI 1.21-12.24，P=0.02）是发生尿路感染的显著危险因素。在 228 例患者中，共鉴定出 100 例（43.9%）感染了六种（21 型）ADV。ADV B 是最常见的物种。ADV B 种（26/60，52.0%或 5/41，12.2%，P=0.001）在 ADV 肺炎患者中更为常见。ADV C（13/15，86.7%与 35/86，40.7%，P=0.001）种在播散性疾病患者中更为常见。在我们的分析中，与角膜炎相关的 ADV 种仅为 ADV D。在 ADV A/B/D 种中观察到尿路感染。在我们的病例中，西多福韦（CDV）（82/228，36.0%）仍然是最常用的抗病毒治疗药物，其次是利巴韦林（15/228，6.6%）、更昔洛韦（18/228，7.9%）和布西福韦（12/228，5.3%）。10 例患者接受布西福韦作为挽救治疗。在 228 例患者中，有 81 例（35.5%）死亡。胃肠道（GI）ADV 感染（5/10，50.0%）、ADV 肺炎（20/45，44.4%）和播散性 ADV 感染（53/122，43.4%）患者的死亡率较高。
结论
先前的实体器官移植、造血干细胞移植和血液恶性肿瘤是播散性 ADV 感染的危险因素。皮质类固醇的使用与尿路感染显著相关。不同的种属与不同的感染临床表现相关。GI 疾病、肺炎和播散性疾病患者的死亡率较高。我们的综述阐明了 ADV 感染的当前治疗方法，更多的治疗方法需要进一步研究。
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