中国肺结核治疗失败影响因素的Meta分析

Meta-analysis of risk factors on pulmonary tuberculosis treatment failure in China

目的探讨肺结核治疗失败的影响因素，为今后防治工作提供依据。方法对PubMed、CNKI、VIP、CBM及万方数据库进行检索关于肺结核治疗失败影响因素的研究（2002—2012年），通过Meta分析，报告危险因素的合并OR（95％CI）值。结果共纳入符合标准的文献15篇，单因素分析，合并OR（95％CI）值分别为：合并症2．71（1．99～3．70）、肺病空洞2．16（1．75～2．66）、病变肺野数4．88（2．76～8．62）、低蛋白血症3．57（2．61～4．90）、不规律治疗28．09（4．90—161．06）、治疗延误〉3个月5．42（1．53—19．15）、吸烟3．47（2．20～5．46）、不良反应2．08（1．46～2．98）、耐药3．30（1．24—8．76）；多因素分析，OR（95％CI）值分别为：合并症2．51（1．85～3．41）、肺部空洞1．77（1．39—2．26）、病变肺野数1．38（1．26～1．51）、不规律治疗19．83（2．83—138．76）、治疗延误〉3个月2．35（1．42～3．91）、不良反应2．14（1．49—3．06）、耐药2．45（1．37—4．38），指标差异均有统计学意义。结论合并症、肺部空洞、病变肺野数、低蛋白血症、不规律治疗、治疗延误、吸烟、不良反应、耐药均是肺结核治疗失败的影响因素。

Objective To synthetically evaluate the risk factors of pulmonary tuberculosis treatment failure in Chi- na and provide evidence for further study and intervention. Methods PubMed, CNKI,VIP,CBM and Wan Fang database were searched for the studies on the risk factors of tuberculosis treatment failure（2002 -2012）. Pooled OR and their 95 % CI were estimated using data extracted from those papers. Results A total of 15 studies were included~ The merged OR values and their 95% C1 of single-factor-analysis for complications, status of cavitas, numbers of lung lobes lesion, hy- poalbuminemia, irregular therapy, time of delayed treatment （ more than three month）, smoking, adverse reaction, drug re- sistance were as follows ： 2. 71 （ 1.99-3.70 ）, 2. 16 （ 1.75-2. 66 ）, 4. 88 （ 2. 76-8.62 ）, 3.57 （ 2. 61-4. 90 ）, 28.09 （ 4. 90- 161.06） ,5.42（ 1.53-19. 15） ,3.47（2. 20-5.46）, 2.08（ 1.46-2. 98）, 3.30（1.24-8.76）. And the merged OR values and their 95% CI of multiple-factor-analysis for complications, status of cavitas,numbers of lung lobes lesion, irregular thera- py, time of delayed treatment （ more than three month ） , adverse reaction, drug resistance were as follows ： 2. 51 （ 1.85- 3.41）,1.77（1.39-2.26）,1.38（1.26-1.51）, 19.83（2.83-138.76）, 2.35 （1.42-3.91）,2.14（1.49-3.06）,2.45 （ 1.37-4. 38）. All of those factors were statistically significant. Conclusions Complications, status of cavitas, numbers of lung lobes lesion, hypoalbuminemia, irregular therapy, time of delayed treatment （more than three month）, smoking, ad- verse reaction, drug resistance were considered to be the risk factors of pulmonary treatment failure.