Article(id=1321170641131258505, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170430187130949, articleNumber=null, orderNo=null, doi=10.11847/zgggws1144785, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1682092800000, receivedDateStr=2023-04-22, revisedDate=1693584000000, revisedDateStr=2023-09-02, acceptedDate=1731945600000, acceptedDateStr=2024-11-19, onlineDate=1792921227009, onlineDateStr=2026-10-25, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921227009, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921227009, creator=13701087609, updateTime=1792921227009, updator=13701087609, issue=Issue{id=1321170430187130949, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='2', pageStart='129', pageEnd='256', issueExtLink='null', onlineDate='null', pubDate='1739116800000', pubDateStr='2025-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921176716, creator='13701087609', updateTime=1792921176716, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=234, endPage=238, ext={EN=ArticleExt(id=1321170641340973706, articleId=1321170641131258505, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Positive rates of hepatitis E virus IgG antibodies in pregnant women in China: a meta-analysis, columnId=1320427670123430037, journalTitle=Chinese Journal of Public Health, columnName=Evidence-Based Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the positive rate of hepatitis E virus (HEV) immunoglobulin G (IgG) antibodies in pregnant women in China and to provide a reference for the prevention and control of hepatitis E in the women.

Methods

PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched, supplemented by a retrospective literature search, to collect relevant literature published domestically and internationally from January 1, 1989, to December 31, 2023, on the seroprevalence of HEV in pregnant women in China. R 3.5.2 software was used for meta-analysis of the included literature.

Results

A total of 15 articles (8 in Chinese and 7 in English) were included, with a cumulative study population of 36 188. The meta-analysis showed that the positive rate of HEV IgG antibodies among pregnant women in China was 13% (95% confidence interval [95%CI]: 11%–16%). Subgroup analysis showed that the positive rates of HEV IgG antibodies in pregnant women younger than 30 years old and 30 years old and older were 18% (95%CI: 12%–24%) and 15% (95%CI: 10%–19%), respectively; the positive rates of HEV IgG antibodies in pregnant women living in urban and rural areas were 29% (95%CI: 3%–55%) and 25% (95%CI: 5%–45%), respectively; and the positive rates of HEV IgG antibodies in pregnant women in the first, second, and third trimesters were 16% (95%CI: 3%–28%), 13% (95%CI: 7%–18%), and 15% (95%CI: 10%–21%), respectively. There were no statistically significant differences in the positive rates of HEV IgG antibodies among pregnant women of different ages, residences, and gestational ages (all P>0.05). Sensitivity analysis and publication bias tests showed that there was no publication bias in the literature included in this meta-analysis, and the results were relatively stable.

Conclusions

The positive rate of HEV IgG antibodies among pregnant women in China is relatively high. Attention should be paid to this high-risk group, and prevention and control measures for HEV infection should be strengthened.

, authors=Qixin XIE1, Chunmei YE2, Zhaojun LU1, Wenwen GU1, Jing WANG1, Jian DU1, Yingying YANG1, Yan LIU1, authorsList=Qixin XIE, Chunmei YE, Zhaojun LU, Wenwen GU, Jing WANG, Jian DU, Yingying YANG, Yan LIU, authorCompany=null, correspAuthors=Yan LIU, authorNote=null, correspAuthorsNote=
LIU Yan, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321170643605897871, articleId=1321170641131258505, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=中国妊娠期妇女戊型肝炎病毒IgG抗体阳性率meta分析, columnId=1320427670287007895, journalTitle=中国公共卫生, columnName=循证医学, runingTitle=null, highlight=null, articleAbstract=
目的

了解中国妊娠期妇女戊型肝炎病毒(HEV)免疫球蛋白G(IgG)抗体的阳性率,为我国妊娠期妇女戊型肝炎的预防控制提供参考依据。

方法

检索Pubmed、Web of Science、中国知网和万方资源数据库,并辅以文献追溯法收集1989年1月1日—2023年12月31日国内外公开发表的中国妊娠期妇女HEV血清流行率调查的相关文献;应用R 3.5.2软件对纳入的文献进行meta分析。

结果

最终纳入15篇文献(中文文献8篇、英文文献7篇),累计研究对象36 188人;meta分析结果显示,中国妊娠期妇女HEV IgG抗体阳性率为13%(95%CI=11%~16%);亚组分析结果显示,年龄<30岁和≥30岁妊娠期妇女的HEV IgG抗体阳性率分别为18%(95%CI=12%~24%)和15%(95%CI=10%~19%),居住在城市和农村地区妊娠期妇女的HEV IgG抗体阳性率分别为29%(95%CI=3%~55%)和25%(95%CI=5%~45%),孕早期、孕中期和孕晚期妊娠期妇女的HEV IgG抗体阳性率分别为16%(95%CI=3%~28%)、13%(95%CI=7%~18%)和15%(95%CI=10%~21%),不同年龄、居住地和孕期妊娠期妇女HEV IgG抗体阳性率差异均无统计学意义(均P>0.05);敏感性分析和发表偏倚检验结果显示,本次meta分析纳入的文献不存在发表偏倚,结果较为稳定。

结论

中国妊娠期妇女HEV IgG抗体阳性率较高,应重点关注妊娠期妇女这一高危人群,做好HEV感染的防控工作。

, authors=谢启新1, 叶春梅2, 卢肇骏1, 顾雯雯1, 王婧1, 杜渐1, 杨瑛莹1, 刘艳1, *, *, authorsList=谢启新, 叶春梅, 卢肇骏, 顾雯雯, 王婧, 杜渐, 杨瑛莹, 刘艳, authorCompany=null, correspAuthors=刘艳, authorNote=

谢启新(1996—),医师,硕士,研究方向:流行病学

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刘艳,E-mail:
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First author, year of publication, study area, sample size, number of positives, positive rate, study type, quality score, and quality level for the 15 included studies

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第一作者发表年份研究地区样本量/人IgG抗体阳性数/人IgG抗体阳性率/%研究类型质量评分/分质量评价
Wen G P[14]2023福建424444510.49队列研究9高
Qian Z Y[15]2022云南19 7622 27511.51队列研究9高
Ma X X[16]2020内蒙古3 2782066.28队列研究8高
卜秋宁[17]2019河北86413515.63队列研究9高
张文静[18]2019山东651172.61横断面研究16高
Rui Z L[19]2018江苏2254921.78队列研究8高
吕必华[20]2018湖北4468819.73队列研究9高
卓卫[21]2017福建91014015.38横断面研究15高
Gu G Y[22]2015江苏4975511.07横断面研究16高
周璇[23]2015江苏91212413.60横断面研究15高
Cong W[24]2014山东99016016.16队列研究8高
王强[25]2014湖北2 81242215.01横断面研究15高
Huang F[26]2013云南2933010.24横断面研究12中
李丽[27]2013云南1491510.07横断面研究12中
蒋理[28]2009江苏1553925.16队列研究8高
), ArticleFig(id=1321170649255625423, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170641131258505, language=CN, label=表1, caption=

纳入文献基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
第一作者发表年份研究地区样本量/人IgG抗体阳性数/人IgG抗体阳性率/%研究类型质量评分/分质量评价
Wen G P[14]2023福建424444510.49队列研究9高
Qian Z Y[15]2022云南19 7622 27511.51队列研究9高
Ma X X[16]2020内蒙古3 2782066.28队列研究8高
卜秋宁[17]2019河北86413515.63队列研究9高
张文静[18]2019山东651172.61横断面研究16高
Rui Z L[19]2018江苏2254921.78队列研究8高
吕必华[20]2018湖北4468819.73队列研究9高
卓卫[21]2017福建91014015.38横断面研究15高
Gu G Y[22]2015江苏4975511.07横断面研究16高
周璇[23]2015江苏91212413.60横断面研究15高
Cong W[24]2014山东99016016.16队列研究8高
王强[25]2014湖北2 81242215.01横断面研究15高
Huang F[26]2013云南2933010.24横断面研究12中
李丽[27]2013云南1491510.07横断面研究12中
蒋理[28]2009江苏1553925.16队列研究8高
), ArticleFig(id=1321170649326928592, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170641131258505, language=EN, label=Tab.2, caption=

Subgroup analysis of HEV IgG antibody positive rates in pregnant women in China: number of studies, heterogeneity test, effect model, positive rate based on meta-analysis by age, residential area, and study quality

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组别分类文献数异质性检验结果效应模型meta分析
I2值Q值P值HEV IgG抗体阳性率95%CIP值
年龄/岁<301199.0%954.07<0.001随机18%12%~24%0.385
≥301191.8%121.49<0.001随机15%10%~19%
居住地城市398.9%181.42<0.001随机29%3%~55%0.794
农村398.6%141.88<0.001随机25%5%~45%
文献质量孕早期798.7%449.20<0.001随机16%3%~28%0.775
孕中期796.4%168.59<0.001随机13%7%~18%
孕晚期794.3%105.17<0.001随机15%10%~21%
), ArticleFig(id=1321170649406620369, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170641131258505, language=CN, label=表2, caption=

中国不同亚组妊娠期妇女HEV IgG抗体阳性率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别分类文献数异质性检验结果效应模型meta分析
I2值Q值P值HEV IgG抗体阳性率95%CIP值
年龄/岁<301199.0%954.07<0.001随机18%12%~24%0.385
≥301191.8%121.49<0.001随机15%10%~19%
居住地城市398.9%181.42<0.001随机29%3%~55%0.794
农村398.6%141.88<0.001随机25%5%~45%
文献质量孕早期798.7%449.20<0.001随机16%3%~28%0.775
孕中期796.4%168.59<0.001随机13%7%~18%
孕晚期794.3%105.17<0.001随机15%10%~21%
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中国妊娠期妇女戊型肝炎病毒IgG抗体阳性率meta分析
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谢启新 1 , 叶春梅 2 , 卢肇骏 1 , 顾雯雯 1 , 王婧 1 , 杜渐 1 , 杨瑛莹 1 , 刘艳 1, *, *
中国公共卫生 | 循证医学 2025,41(2): 234-238
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中国公共卫生 |循证医学 2025 , 41 (2) : 234 -238
中国妊娠期妇女戊型肝炎病毒IgG抗体阳性率meta分析
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谢启新1, 叶春梅2, 卢肇骏1, 顾雯雯1, 王婧1, 杜渐1, 杨瑛莹1, 刘艳1, *, *
作者信息
  • 1杭州市疾病预防控制中心(杭州市卫生监督所),杭州 310000
  • 2杭州市临平区疾病预防控制中心(杭州市临平区卫生监督所),杭州 311222
通讯作者:
刘艳,E-mail:
作者简介:

谢启新(1996—),医师,硕士,研究方向:流行病学

Positive rates of hepatitis E virus IgG antibodies in pregnant women in China: a meta-analysis
Qixin XIE1, Chunmei YE2, Zhaojun LU1, Wenwen GU1, Jing WANG1, Jian DU1, Yingying YANG1, Yan LIU1
Affiliations
  • 1Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou 310000, China
  • 2Hangzhou Linping District Center for Disease Control and Prevention (Hangzhou Linping District Health Supervision Institution), Hangzhou 311222, China
  • Corresponding Author:
    LIU Yan, E-mail:
出版时间: 2025-02-10 doi: 10.11847/zgggws1144785
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目的

了解中国妊娠期妇女戊型肝炎病毒(HEV)免疫球蛋白G(IgG)抗体的阳性率,为我国妊娠期妇女戊型肝炎的预防控制提供参考依据。

方法

检索Pubmed、Web of Science、中国知网和万方资源数据库,并辅以文献追溯法收集1989年1月1日—2023年12月31日国内外公开发表的中国妊娠期妇女HEV血清流行率调查的相关文献;应用R 3.5.2软件对纳入的文献进行meta分析。

结果

最终纳入15篇文献(中文文献8篇、英文文献7篇),累计研究对象36 188人;meta分析结果显示,中国妊娠期妇女HEV IgG抗体阳性率为13%(95%CI=11%~16%);亚组分析结果显示,年龄<30岁和≥30岁妊娠期妇女的HEV IgG抗体阳性率分别为18%(95%CI=12%~24%)和15%(95%CI=10%~19%),居住在城市和农村地区妊娠期妇女的HEV IgG抗体阳性率分别为29%(95%CI=3%~55%)和25%(95%CI=5%~45%),孕早期、孕中期和孕晚期妊娠期妇女的HEV IgG抗体阳性率分别为16%(95%CI=3%~28%)、13%(95%CI=7%~18%)和15%(95%CI=10%~21%),不同年龄、居住地和孕期妊娠期妇女HEV IgG抗体阳性率差异均无统计学意义(均P>0.05);敏感性分析和发表偏倚检验结果显示,本次meta分析纳入的文献不存在发表偏倚,结果较为稳定。

结论

中国妊娠期妇女HEV IgG抗体阳性率较高,应重点关注妊娠期妇女这一高危人群,做好HEV感染的防控工作。

戊型肝炎病毒(HEV)  /  免疫球蛋白G(IgG)抗体  /  阳性率  /  妊娠期妇女  /  中国  /  meta分析
Objective

To investigate the positive rate of hepatitis E virus (HEV) immunoglobulin G (IgG) antibodies in pregnant women in China and to provide a reference for the prevention and control of hepatitis E in the women.

Methods

PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched, supplemented by a retrospective literature search, to collect relevant literature published domestically and internationally from January 1, 1989, to December 31, 2023, on the seroprevalence of HEV in pregnant women in China. R 3.5.2 software was used for meta-analysis of the included literature.

Results

A total of 15 articles (8 in Chinese and 7 in English) were included, with a cumulative study population of 36 188. The meta-analysis showed that the positive rate of HEV IgG antibodies among pregnant women in China was 13% (95% confidence interval [95%CI]: 11%–16%). Subgroup analysis showed that the positive rates of HEV IgG antibodies in pregnant women younger than 30 years old and 30 years old and older were 18% (95%CI: 12%–24%) and 15% (95%CI: 10%–19%), respectively; the positive rates of HEV IgG antibodies in pregnant women living in urban and rural areas were 29% (95%CI: 3%–55%) and 25% (95%CI: 5%–45%), respectively; and the positive rates of HEV IgG antibodies in pregnant women in the first, second, and third trimesters were 16% (95%CI: 3%–28%), 13% (95%CI: 7%–18%), and 15% (95%CI: 10%–21%), respectively. There were no statistically significant differences in the positive rates of HEV IgG antibodies among pregnant women of different ages, residences, and gestational ages (all P>0.05). Sensitivity analysis and publication bias tests showed that there was no publication bias in the literature included in this meta-analysis, and the results were relatively stable.

Conclusions

The positive rate of HEV IgG antibodies among pregnant women in China is relatively high. Attention should be paid to this high-risk group, and prevention and control measures for HEV infection should be strengthened.

hepatitis E virus  /  immunoglobulin G antibody  /  positive rate  /  pregnant women  /  China  /  meta-analysis
谢启新, 叶春梅, 卢肇骏, 顾雯雯, 王婧, 杜渐, 杨瑛莹, 刘艳. 中国妊娠期妇女戊型肝炎病毒IgG抗体阳性率meta分析. 中国公共卫生, 2025 , 41 (2) : 234 -238 . DOI: 10.11847/zgggws1144785
Qixin XIE, Chunmei YE, Zhaojun LU, Wenwen GU, Jing WANG, Jian DU, Yingying YANG, Yan LIU. Positive rates of hepatitis E virus IgG antibodies in pregnant women in China: a meta-analysis[J]. Chinese Journal of Public Health, 2025 , 41 (2) : 234 -238 . DOI: 10.11847/zgggws1144785
戊型肝炎是戊型肝炎病毒(hepatitis E virus,HEV)感染引起的一种急性传染性疾病,其在发展中国家尤其是工业化国家中是一个严重的公共卫生问题[1]。2015年世界卫生组织(World Health Organization,WHO)报道,全球约有44 000人死于HEV感染,占病毒性肝炎死亡率的3.3%[2]。研究表明,戊型肝炎的病死率为0.2%~4%,在高危人群中可能更高,其主要易感人群为孕妇,孕妇妊娠晚期HEV感染病死率可高达10%~25%[3]。还有研究表明,妊娠期戊型肝炎的发病率较高,妊娠期间HEV感染可导致暴发性肝衰竭、胎膜破裂、自然流产和死产的暴发性进展[4],病死率可高达30%[5]。近年来,中国戊型肝炎的发病率呈总体上升的趋势,其发病数和死亡数已连续多年超过甲型肝炎,对患者的生命安全和生命质量均造成严重影响[6–8]。血清流行病学研究表明,妊娠期妇女普遍存在HEV易感,不同地区妊娠期妇女HEV免疫球蛋白G(immunoglobulin G,IgG)阳性率差异较大[9–10],但目前尚缺乏全国范围内对妊娠期妇女HEV IgG抗体阳性率的系统性研究。为了解中国妊娠期妇女HEV IgG抗体的阳性率,为我国妊娠期妇女戊型肝炎的预防控制提供参考依据,本研究通过收集1989年1月1日—2023年12月31日国内外公开发表的中国妊娠期妇女HEV血清流行率调查的相关文献,对我国妊娠期妇女HEV IgG抗体的阳性率进行meta分析。结果报告如下。
在PubMed数据库、Web of Science数据库、中国知网数据库和万方数据资源库中检索国内外1989年1月1日—2023年12月31日公开发表的中国妊娠期妇女HEV血清流行率调查的相关文献,末次检索日期为2024年1月17日。中文检索关键词为:“戊型肝炎/戊型肝炎病毒/戊肝” “妊娠期/孕妇” “中国/中国人”;英文检索关键词为:“hepatitis E/hepatitis E virus/HEV”“pregnancy/pregnant woman”“China/Chinese”。同时辅以手工检索和文献追溯法收集更多相关文献。
纳入标准:(1)研究对象为妊娠期妇女,包括不同孕期孕妇人群;(2)血清流行率数据准确,能提供妊娠期妇女HEV IgG抗体结果的原始数据;(3)采用酶联免疫吸附实验(enzyme-linked immunosorbent assay,ELISA)检测抗HEV IgG;(4)研究地区为中国大陆地区。排除标准:(1)人类免疫缺陷病毒(human immunodeficiency virus,HIV)合并感染者的研究;(2)所需的血清流行率数据不详的研究;(3)综述、重复文章、书籍章节和其他无关研究。
根据纳入与排除标准由2名研究人员独立完成文献筛选和资料提取,若在过程中出现异议,则询问第3名研究人员并决定是否纳入。提取的数据包括第一作者、发表年份、研究地区、样本量、IgG阳性数、IgG阳性率和研究类型等。队列研究和横断面研究分别采用纽卡斯尔–渥太华量表(Newcastle Ottawa Scale,NOS)[11]和澳大利亚循证护理中心(Joanna Briggs Institute,JBI)推荐的观察性研究质量评价标准[12]对纳入的文献进行质量评价。NOS量表评价标准包括人群选择(0~4分)、组间可比性(0~2分)和结局/暴露(0~3分)3个条目,总分为9分,其中≥7分为高质量,4~6分为中等质量,≤3分为低质量;JBI推荐的观察性研究质量评价标准从抽样框架是否适合目标人群、是否详细描述了研究对象和研究场所、是否清晰界定了样本的纳入标准、暴露因素的测量方法是否具有信度和效度、疾病或健康问题的界定是否有客观和一致的标准、混杂因素是否明确、是否采取措施控制混杂因素、结局指标的测量方法是否具有信度和效度、资料分析方法是否恰当9个条目进行质量评价,每个条目按照“不符要求” “提到未详述”和“详细描述”分别赋0、1和2分,总分为18分,其中≥15分为高质量,11~14分为中等质量,≤10分为低质量。
应用R 3.5.2软件进行统计分析,效应量采用HEV IgG抗体阳性率及其95%CI进行描述。采用I2值和Q检验评估纳入研究间的异质性,当I2>50%且Q检验的P<0.05时提示存在异质性,采用随机效应模型分析,反之则采用固定效应模型分析[13]。采用逐一剔除法进行敏感性分析;采用漏斗图和Egger′s检验评价纳入的文献是否存在发表偏倚,若P>0.05且倒漏斗图分布均匀对称,则说明无发表偏倚。
共检索出相关文献617篇(PubMed数据库106篇、Web of Science数据库75篇、中国知网数据库254篇、万方数据资源库182篇),根据阅读论文题目和摘要剔除不相关文献528篇,根据纳入和排除标准剔除文献74篇,最终纳入15篇(中文文献8篇、英文文献7篇)相关文献,具体筛选流程见图1。本研究纳入文献涉及福建、云南、内蒙古、河北、山东、江苏、湖北7个省份(自治区),研究类型包括队列研究和横断面研究,累计研究对象36 188人。各文献质量评价得分为8~16分,其中13篇为高质量文献,2篇为中等质量文献。
对纳入的15篇文献进行异质性检验,文献间存在显著的异质性(I2 =99.0%,P<0.001),故采用随机效应模型。meta分析结果显示,中国妊娠期妇女HEV IgG抗体阳性率为13%(95%CI =11%~16%)。
亚组分析结果显示,年龄<30岁和≥30岁妊娠期妇女的HEV IgG抗体阳性率分别为18%和15%,居住在城市和农村地区妊娠期妇女的HEV IgG抗体阳性率分别为29%和25%,孕早期、孕中期和孕晚期妊娠期妇女的HEV IgG抗体阳性率分别为16%、13%和15%,不同年龄、居住地和孕期妊娠期妇女HEV IgG抗体阳性率差异均无统计学意义(均P>0.05)。
采取逐一剔除对纳入的中国癌症幸存者FoP发病率文献进行敏感性分析,未发现对研究结果有明显影响的文献,提示纳入的文献稳定性较好,meta分析结果较为稳定。本研究漏斗图未发现有明显的不对称,提示存在发表偏倚的可能性较小;Egger′s检验结果亦显示,本次纳入meta分析的文献不存在发表偏倚(t=1.09,P=0.295)。
中国是戊型肝炎高流行地区之一,其总体流行率为7%~15%[29–30]。近年来,HEV感染的发病率和死亡率居高不下,尤其是对妊娠期妇女的影响已引起越来越多学者和研究人员的关注。国内报道妊娠期妇女HEV感染抗体水平的研究较多,但大多为针对某一妊娠阶段或者单一城市的研究,尚缺乏全国范围内妊娠期妇女HEV IgG抗体水平的相关研究。因此,本研究通过收集1989年1月1日—2023年12月31日国内外公开发表的中国妊娠期妇女HEV血清流行率调查的相关文献对我国妊娠期妇女HEV IgG抗体的阳性率进行了meta分析,旨在估算国内妊娠期妇女HEV IgG抗体的总体流行率,使研究人员和政策制定者更好地了解疾病的分布情况,从而有针对性地开展特殊人群戊型肝炎预防控制工作。
本研究meta分析结果显示,中国妊娠期妇女HEV IgG抗体阳性率为13%(95%CI=11%~16%),略低于全球妊娠期妇女HEV IgG抗体阳性率的16.51%(95%CI=10%~23%)[31],但高于普通人群HEV IgG抗体阳性率的10%(95%CI=6.3%~18.4%)[32],提示妊娠期妇女的HEV感染在全球都是一个重要的公共卫生问题,需要采取预防措施对妊娠期妇女这一高危人群加以重点保护。苏丹的一项研究发现孕妇中HEV IgG抗体阳性率高达61.29%[33],在缅甸[9]和埃塞俄比亚[34]对妊娠期妇女进行的HEV IgG血清流行率调查发现其抗体阳性率分别高达42.43%和31.61%,江苏省南京市报道的妊娠期妇女HEV IgG抗体阳性率为25.16%[28],提示妊娠期妇女HEV在部分国家或地区感染率较高,应加强对患者和感染者的诊治和管理,做到早发现、早隔离、早治疗,同时做好整个妊娠期戊型肝炎血清标志物和转氨酶的监测,避免其进一步发展。
研究表明,年龄是影响HEV抗体水平的重要因素[35],不同年龄段妊娠期妇女的HEV IgG抗体水平不一致,国内研究大多将妊娠期妇女的年龄分为<20、21~25、26~30、31~35、36~40和>40岁组[21–23],但不同文献分组形式并不统一,从而导致不同研究的分析结果缺乏一致性。本研究将妊娠期妇女分为<30岁和≥30岁组,分析其HEV IgG抗体的阳性率,结果显示<30岁组妊娠期妇女HEV IgG抗体阳性率(18%)高于≥30岁妊娠期妇女HEV IgG抗体阳性率(15%),与国外研究结果一致[36],表明<30岁妊娠期妇女可能对HEV更为易感。此外,不同地区的经济水平不同,也可能会影响妊娠期妇女HEV的感染情况。本研究分析了城市和农村地区妊娠期妇女HEV IgG抗体阳性状况,发现城市妊娠期妇女HEV IgG抗体阳性率(29%)高于农村妊娠期妇女的HEV IgG抗体阳性率(25%),同时城市和农村妊娠期妇女HEV IgG抗体阳性率均高于本研究总体水平,可能与分析城市和农村地区妊娠期妇女HEV IgG抗体水平时纳入的文献较少有关。
Navaneethan U等[37]研究表明,妊娠合并戊型肝炎感染易发展为肝衰竭,并导致多种不良妊娠结局,尤其是妊娠后期戊型肝炎感染更会对孕产妇造成严重伤害。本研究针对不同妊娠期妇女的HEV IgG抗体阳性状况进行分析,结果显示妊娠期妇女在孕中期的HEV IgG抗体阳性率(13%)低于孕早期(16%)和孕晚期(15%),提示在孕早期和孕晚期需重点注意孕妇的HEV感染情况,警惕突然出现的肝功能异常,并加强HEV的常规监测。
综上所述,中国妊娠期妇女HEV IgG抗体阳性率较高,需重点关注妊娠期妇女这一高危人群,做好HEV感染的防控工作。本研究阐明了HEV在妊娠期妇女中的流行水平,对戊型肝炎防控具有积极的指导意义,可为后续制定相应措施对妊娠期妇女高危人群进行疫苗接种提供数据支撑和循证证据。但本研究仍存在一定的局限性,如,血清流行率仅通过HEV IgG抗体水平来确定,而该水平大多在感染后才会显现,可能会导致妊娠期妇女HEV感染筛查不及时,对meta分析结果有一定的影响;此外,本研究纳入的文献异质性较高,这可能与不同研究的基线特征、样本大小和采样年份不同有关,今后可收集更多研究数据进一步进行meta分析对本研究结果加以验证。

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doi: 10.11847/zgggws1144785
  • 接收时间:2023-04-22
  • 首发时间:2026-10-25
  • 出版时间:2025-02-10
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  • 收稿日期:2023-04-22
  • 修回日期:2023-09-02
  • 录用日期:2024-11-19
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    1杭州市疾病预防控制中心(杭州市卫生监督所),杭州 310000
    2杭州市临平区疾病预防控制中心(杭州市临平区卫生监督所),杭州 311222

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