我国合并糖尿病初治涂阳肺结核患者治疗效果的系统评价和meta分析

Treatment Effect of New Smear Positive Pulmonary Tuberculosis Patients Complicated with Diabetes Mellitus in China:Meta Analysis

目的评价短程化疗方案对合并糖尿病初治涂阳肺结核患者的治疗效果,为制定糖尿病合并结核病治疗规范提供参考。方法在中国知网、万方数据库中检索2001～2010年关于结核病合并糖尿病治疗的中文文献,利用RevMan 4.3软件包进行数据分析,比较结核病合并糖尿病患者和单纯结核病患者应用短程化疗方案的治疗效果,并进行定性分析。结果检索到864篇相关文献,入选206篇,符合标准18篇。治疗2个月末痰菌阴转率:计算得合并OR值为0.29(95%CI 0.22～0.39),差异有统计学意义(P<0.05),糖尿病组的痰菌阴转率低于结核病组。治疗6个月末痰菌阴转率:合并OR值为0.17(95%CI 0.11～0.26),差异有统计学意义(P<0.05),糖尿病合并结核病组痰菌阴转率低于单纯结核病组。血糖控制对结核病治疗影响:1组[空腹血糖(FBG)<8.4mmol/L]+2组(FBG=8.4～14.0mmol/L)+3组(FBG>14mmol/L)与4组(结核病组)比较:P<0.05,1组与4组比较:P>0.05,2组、3组、2组+3组分别与4组比较:均为P<0.05,差异有统计学意义,空腹血糖≥8.4mmol/L时,痰菌阴转率低于单纯结核病患者。结论糖尿病不利于结核病的控制,短程化疗方案对于合并糖尿病的结核病患者治疗效果不理想,控制血糖可提高结核病化疗效果。

Objective To evaluate short course chemotherapy treatment effect of new smear positive pulmonary tuberculosis（TB） patients complicated with diabetes mellitus （DM）. To provide reference for implementing treatment guideline of TB - DM. Methods Data- bases CNKI,WanFang DATA were searched for TB - DM relevant studies and literature in Chinese from 2001 to 2010. RevMan4.3 sefi- ware was applied in the process of analyzing. Compared treatment effect of short course chemotherapy on new smear positive TB - DM pa- tients with TB patients. Results 864 articles were indentified,in which 206 articles were involved, and 18 articles were eligible according to including criteria. Sputum conversion rate by the end of 2th month of treatment ~ the combined OR was 0.29 （95 % CI 0.22 - 0.39 ） ; TB - DM group and TB group were significantly different（P 〈 0.05 ） ; sputum conversion rate of TB - DM group was lower. Sputum conversion rate by the end of 6th month of treatment：the combined OR was O. 17（95% CI 0.11 -0.26） （P 〈0.05） ;sputum conversion rate of TB - DM group was lower. Sputum conversion rate based on blood glucose control： groupl [ fasting blood glucose （FBG） 〈 8.4mmol/L] ＋group2 （ FBG = 8.4 - 14.0mmol/L） ＋ group3 （ FBG 〉 14mmol/L） versus （vs） group4 （ TB group） ： P 〈 0.05, groupl vs group4 ： P 〉 0.05 ; compared group2 group3 and group2 ＋ 3 with group4, respectively： P 〈 0.05. If FBG t〉 8.4mmol/L, sputum conversion rate of TB - DM patients is lower than TB patients. Conclusion DM had a negative effect on the outcome of anti - TB treatment. Short course chemothera- py is not an ideal method for TB - DM patients. Positive blood glucose control would improve TB outcome.