Human herpesvirus infections and dementia or mild cognitive impairment: a systematic review and meta-analysis
Human herpesvirus infections and dementia or mild cognitive impairment: a systematic review and meta-analysis
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DOI：
10.1038/s41598-019-41218-w
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发表时间：
2019-03-18
影响因子：
4.6
通讯作者：
Smeeth, Liam
中科院分区：
文献类型：
--
作者：
Warren-Gash, Charlotte;Forbes, Harriet J.;Smeeth, Liam
越来越多的人对感染因子在痴呆发病机制中的作用感兴趣，但目前的证据有限。我们进行了一项系统回顾和荟萃分析，以调查八种人类疱疹病毒中的任何一种对痴呆或轻度认知障碍（MCI）发展的影响。我们检索了科克伦图书馆、Embase、Global Health、Medline、PsycINFO、Scopus、Web of Science、临床试验登记和灰色文献来源，从开始到2017年12月，寻找具有队列、病例对照或自身对照设计的观察性研究，或针对疱疹病毒干预的随机对照试验。通过对具有相同设计、结局和病毒类型、方法和测量部位的研究进行随机效应荟萃分析，生成合并效应估计值和95%置信区间（CI）。我们纳入了57项不同地理环境的研究。过去感染疱疹病毒，测量IgG血清阳性，一般与痴呆症的风险。一项评价为中等质量的单一队列研究显示水痘带状疱疹病毒再激活（眼带状疱疹）与痴呆事件之间存在相关性（HR 2.97; 95%CI，1.89 - 4.66）。通过血清IgM、高滴度IgG或临床疾病测量的单纯疱疹病毒1型或未指明的1/2型、巨细胞病毒和人疱疹病毒-6近期感染或再激活可能与痴呆或MCI相关，尽管研究结果不一致，总体证据质量非常低。需要在足够接近痴呆发作时进行强有力的重复病毒测量的纵向人群研究，以确定疱疹病毒是否、何时以及在哪些人群中影响痴呆风险。
Interest is growing in the role of infectious agents in the pathogenesis of dementia, but current evidence is limited. We conducted a systematic review and meta-analysis to investigate the effect of any of eight human herpesviruses on development of dementia or mild cognitive impairment (MCI). We searched the Cochrane Library, Embase, Global Health, Medline, PsycINFO, Scopus, Web of Science, clinical trials registers and grey literature sources from inception to December 2017 for observational studies with cohort, case control or self-controlled designs, or randomised controlled trials of interventions against herpesviruses. Pooled effect estimates and 95% confidence intervals (CIs) were generated through random effects meta-analyses across studies with the same design, outcome, and virus type, method and site of measurement. We included 57 studies across various geographic settings. Past infection with herpesviruses, measured by IgG seropositivity, was generally not associated with dementia risk. A single cohort study rated moderate quality showed an association between varicella zoster virus reactivation (ophthalmic zoster) and incident dementia (HR 2.97; 95%CI, 1.89 to 4.66). Recent infection with, or reactivation of, herpes simplex virus type 1 or type 1/2 unspecified, cytomegalovirus and human herpes virus-6 measured by serum IgM, high titre IgG or clinical disease may be associated with dementia or MCI, though results were inconsistent across studies and overall evidence rated very low quality. Longitudinal population studies with robust repeated virus measurements taken sufficiently proximal to dementia onset are needed to establish whether, when and among whom herpesviruses affect dementia risk.