HIV/AIDS患者预防性抗结核治疗临床疗效的Meta分析

Preventive effects of antituberculosis drugs in HIV/AIDS persons:a meta-analysis

目的运用Meta分析评价对HIV/AIDS患者行预防性抗结核治疗的临床疗效。方法检索中国期刊全文数据库、中国生物医学文献数据库、维普数据库、PubMed和Cochrane数据库于1990年1月1日—2017年6月10日期间发表的相关研究。严格按照纳入和排除标准筛选文献,采用Cochrane偏倚风险评估工具评价纳入文献质量,并采用Stata14.0软件进行Meta分析。结果本研究最终纳入15项随机对照试验,共计10 873例患者。质量评价显示9项研究判断为低风险,4项为风险未知,2项为高风险。Meta分析结果显示,预防性抗结核治疗可显著降低PPD阳性(RR=0.53,95%CI 0.36~0.79,P=0.002)和PPD阴性(RR=0.62,95%CI 0.42~0.90,P=0.013)HIV/AIDS患者的结核病发病率,且单用异烟肼或联合使用多种抗结核药物均有效。整体上,预防性抗结核治疗可能降低患者死亡率(RR=0.88,95%CI 0.80~0.98,P=0.016),但并未改善HIV/AIDS患者的病情进展(RR=0.93,95%CI 0.75~1.15,P=0.512)。此外,单用异烟肼或联合使用多种抗结核药物并未显著增加HIV/AIDS患者不良反应的发生。结论预防性抗结核治疗在PPD阳性和PPD阴性HIV/AIDS患者中均能有效预防结核病的发生,且并不显著增加患者的不良反应,具有重要的临床应用价值。

Objective To assess the preventive effects of antituberculosis drugs in HIV/AIDS persons by meta-analysis. Methods The articles were searched from CNKI, CBM, VIP, PubMed and Cochrane library before June 10, 2017. The potentially relative studies were selected according to the inclusion and exclusion criteria and the quality was evaluated with the Cochrane risk of bias tool. This meta-analysis was performed by using Stata 14.0 software. Results Fifteen randomized controlled trials, a total of 10 873 HIV/AIDS persons, were included in the meta-analysis. The quality assessment indicated that 9 studies were low risk, 4 were unclear and 2 were high risk of bias. According to the results, the preventive therapy with isoniazid or multiple antituberculosis drugs could significantly reduce the incidence of tuberculosis in purified protein derivative （PPD） positive （RR=0.53, 95%CI 0.36-0.79, P=0.002） and PPD negative （RR=0.62, 95%CI 0.42-0.90, P=0.013） HIV/AIDS persons. Generally, the antituberculosis drugs prophylaxis might decrease the mortality with a critical statistical significance （RR=0.88, 95%CI 0.80-0.98, P=0.016）, but not for the improvement of HIV progression （RR = 0.93, 95%CI 0.75- 1.15, P=0.512）. In addition, in comparison with the controls, neither isoniazid nor multiple antituberculosis drugs could increase the incidence of adverse events in HIV/AIDS persons. Conclusions This meta-analysis suggests that antituberculosis drugs prophylaxis has promising preventive effects and can significantly reduce the incidence of tuberculosis without serious adverse events in both PPD positive and PPD negative HIV/AIDS persons.