Portal de Periódicos da CAPES

Enterovirus infection and type 1 diabetes mellitus: systematic review and meta-analysis of observational molecular studies

2011; BMJ; Volume: 342; Issue: feb03 1 Linguagem: Inglês

10.1136/bmj.d35

0959-8138

Wing‐Chi G. Yeung, William D. Rawlinson, Maria E. Craig,

Viral gastroenteritis research and epidemiology

Objective To review the association between current enterovirus infection diagnosed with molecular testing and development of autoimmunity or type 1 diabetes. Design Systematic review and meta-analysis of observational studies, analysed with random effects models. Data sources PubMed (until May 2010) and Embase (until May 2010), no language restrictions, studies in humans only; reference lists of identified articles; and contact with authors. Study eligibility criteria Cohort or case-control studies measuring enterovirus RNA or viral protein in blood, stool, or tissue of patients with pre-diabetes and diabetes, with adequate data to calculate an odds ratio and 95% confidence intervals. Results The 24 papers and two abstracts (all case-control studies) that met the eligibility criteria included 4448 participants. Study design varied greatly, with a high level of statistical heterogeneity. The two separate outcomes were diabetes related autoimmunity or type 1 diabetes. Meta-analysis showed a significant association between enterovirus infection and type 1 diabetes related autoimmunity (odds ratio 3.7, 95% confidence interval 2.1 to 6.8; heterogeneity χ 2 /df=1.3) and clinical type 1 diabetes (9.8, 5.5 to 17.4; χ 2 /df=3.2). Conclusions There is a clinically significant association between enterovirus infection, detected with molecular methods, and autoimmunity/type 1 diabetes. Larger prospective studies would be needed to establish a clear temporal relation between enterovirus infection and the development of autoimmunity and type 1 diabetes.