摘要目的 系统性评价先驱治疗和普遍预防两种方案预防肾移植后巨细胞病毒(CMV)感染的有效性.方法 检索PubMed、EMbase、Cochrane Library、万方医学网、中国生物医学期刊引文数据库,纳入比较先驱治疗和普遍预防两种方案降低肾移植受者术后CMV感染和CMV病的发生率的随机对照试验.由2名评价者根据人群、干预措施和试验结果进行文献筛选及质量评价.最终对纳入研究的文献结果进行荟萃分析.结果 共纳入6篇文献,涉及752例肾移植受者.荟萃分析结果表明,普遍预防方案在减少肾移植受者术后3和12个月CMV感染风险及降低术后12个月CMV病的发生风险方面均优于先驱治疗方案(相对危险度=12.13,95％可信区间为6.59～22.36,P＜0.05;相对危险度=2.21,95 ％可信区间为1.62～3.01,P＜0.05;相对危险度=1.79,95％可信区间为1.22～2.63,P＜0.05);两组间术后机会性感染和急性排斥反应发生率的差异无统计学意义(P＞0.05).结论 普遍预防方案在降低肾移植受者术后CMV感染和CMV病的发生率均较先驱治疗方案具有优势.

abstractsObjective To assess the efficacy of the two antiviral medications in preventing cytomegalovirus infection and cytomegalovirus disease in renal transplant recipients.Method We searched articles from Pubmed,EMbase,Cochrane Library,Wanfang Med Online,and China's biomedical journal citation database on line.Randomized controlled trials evaluating preemptive treatment and universal prophylaxis for cytomegalovirus infection and cytomegalovirus disease in renal transplant recipients were reviewed.Two reviewers screened studies and assessed study quality according to the study population,intervention measure and results.Finally data from included studies were subjected to meta-analysis.Result Six studies involving total 752 renal transplant recipients were included in this review.Compared with preemptive treatment,universal prophylaxis significantly reduced the risk of cytomegalovirus infection at 3 rd and 12 th month,and the risk of cytomegalovirus disease at 12 th month after transplantation (RR =12.13,95 ％ CI.6.59～22.36,P＜0.05; RR =2.21,95％CI:1.62～3.01,P＜0.05; RR=1.79,95％Chl.22～2.63,P＜0.05).There was no statistically significant difference in the incidence of other opportunistic infection and acute rejection.Conclusion Universal prophylaxis was more effective than preemptive treatment in preventing CMV infection and CMV disease in renal transplant recipients.