成年人侵入性肺炎球菌病的风险条件:系统性审查和元分析
Kim Ditzel1, Federica Giardina2, Jaap Ten Oever3
1Department of Pulmonary Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
侵袭性肺炎球菌病 (IPD) 的风险在成年人中很高,像移植接收者这样的免疫损害条件构成最大的威胁. 年龄是一个不那么重要的因素比成人IPD的特定风险条件.
科学领域:
- 传染性疾病 传染性疾病
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 侵入性肺炎球菌病 (IPD) 仍然是成年人的重大健康问题,尽管存在疫苗接种策略.
- 目前的预防工作主要针对年龄组,忽视了各种风险状况.
- 本研究研究了各种风险状况对成年人IPD发病率的相对影响.
研究的目的:
- 系统地审查和量化与成人IPD相关的风险状况的重要性.
- 为了比较不同条件和人口因素所带来的风险.
- 为制定更有针对性和有效的IPD预防计划提供信息.
主要方法:
- 在PubMed和Embase上进行了系统的文献搜索,寻找报告成人IPD风险估计的研究.
- 用随机效应模型对95%的置信区间 (CI) 的聚合发病率比率 (IRR) 进行了元分析.
- 偏差风险和证据确定性分别使用ROBINS-E和GRADE进行评估.
主要成果:
- 确定了50多种风险状况,合成为22个风险领域.
- 成人IPD的最高IRR被观察到在免疫功能受损的条件:移植受体 (30.75),阿斯普莱尼亚 (24.29),艾滋病毒感染者 (PLWH) (21.87),和血液恶性瘤 (19.63).
- 患有慢性病的年轻人 (<65岁) 与老年人 (5.12) 相比,显示出更高的IRR (18.40). 年龄本身对风险的影响很小.
结论:
- 免疫性疾病是成年人IPD最重要的风险因素.
- 风险状况的相对重要性在年轻的成年人群中更为明显.
- 需要进一步的研究,以了解多病症对成人IPD风险的累积影响.
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