中国复治肺结核不良治疗结局危险因素的Meta分析

Risk Factors of Retreatment Pulmonary Tuberculosis Patients with Unfavorable Treatment Outcome in China:A Meta-analysis

目的系统评价复治肺结核治疗发生不良结局的影响因素。方法计算机检索CNKI、VIP、CBM和Wan Fang Data数据库,搜集关于复治肺结核治疗发生不良结局影响因素的研究,检索时限均为从建库至2015年11月15日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果最终纳入13个研究。Meta分析结果显示:在单因素分析中,标准复治方案[OR=4.98,95%CI(2.95,8.39),P<0.000 01]、耐药[OR=4.22,95%CI(1.85,9.63),P=0.000 6]、耐多药[OR=7.19,95%CI(2.51,20.58),P=0.000 2]、肺部有空洞[OR=1.80,95%CI(1.20,2.71),P=0.005]、合并糖尿病[OR=2.05,95%CI(1.30,3.22),P=0.002]、痰菌含量[OR=2.07,95%CI(1.30,3.29),P=0.002]与复治肺结核不良治疗结局相关;在多因素分析中,合并糖尿病[OR=3.38,95%CI(1.56,7.29),P=0.002]与复治肺结核不良治疗结局相关。结论现有证据表明,合并糖尿病、标准复治方案、耐药、耐多药、肺部有空洞、痰菌含量>2+均是复治肺结核患者治疗发生不良结局的危险因素,尤其对于合并糖尿病的患者需要加强管理,从而降低复治失败率。受纳入研究数量和质量的限制,上述结论尚待进一步开展更多高质量的研究加以验证。

Objective To systematically review the risk factors of retreatment pulmonary tuberculosis with unfavorable treatment outcome. Methods We electronically searched databases including CNKI, VIP, CBM and WanFang Date from inception to November 15th 2015, to collect studies about the risk factors of retreatment pulmonary tuberculosis patients with unfavorable treatment outcome. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using RevMan 5.3 software. Results A total of 13 studies were included. The results of meta-analysis showed that significant association was found between retreatment pulmonary tuberculosis cases with unfavorable treatment outcome and such factors as the standard retreatment regimen （OR=4.98, 95%CI 2.95 to 8.39, P〈0.000 01）, drug-resistance （OR=4.22, 95%CI 1.85 to 9.63, P=0.000 6）, multi-drug resistance （OR=7.19, 95%CI 2.51 to 20.58, P=0.000 2）, status of cavitas （OR=1.80, 95%CI 1.20 to 2.71, P=0.005）, TB-diabetes mellitus （OR=2.05, 95%CI 1.30 to 3.22, P=0.002） and high sputum smear load 〉2＋ （OR=2.07, 95%CI 1.30 to 3.29, P=0.002） in univariate-analysis, respectively. But, in multivariate-analysis, only TB- diabetes mellitus （OR=3.38, 95%C! 1.56 to 7.29, P=0.002） showed significant association with retreatment pulmonary tuberculosis cases with unfavorable treatment outcome. Conclusion Current evidence shows that TB-diabetes mellitus, standard retreatment regimen, drug-resistance, multi-drug resistance, status of cavitas and high sputum smear load 〉2＋are considered to be the risk factors for retreatment pulmonary tuberculosis cases with unfavorable treatment outcome. Especially, for patients with diabetes, the importance of management need to be reinforced to reduce the failure rate in the retreatment of pulmonary tuberculosis. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.