艾滋病合并肺结核与单纯肺结核患者胸部影像学表现差异的Meta分析

Meta-analysis on chest imaging features differences between pulmonary tuberculosis patients with AIDS and pure pulmonary tuberculosis patients

利用Meta分析的方法分析艾滋病合并肺结核与单纯肺结核患者胸部影像学表现差异，提高对艾滋病合并肺结核的影像诊断水平。方法 通过计算机检索检索中国期刊全文数据库(1979—2017)、维普中文科技期刊数据库(1989—2017)、万方数据库(1998—2017)和PubMed(1966—2017)数据库有关艾滋病合并肺结核与单纯肺结核患者胸部影像学表现比较的13篇研究文献，应用Meta分析对符合纳入标准的文献进行异质性检验以及合并相对危险度（RR合并）和95%可信区间（95%CI）的计算。采用随机效应模型分析渗出、空洞和粟粒性病灶发生情况；采用固定效应模型分析胸腔积液和纵隔肺门淋巴结肿大发生情况。结果 主要影像学征象的RR合并（95%CI）值分别为：渗出1.25（1.07，1.47），胸腔积液2.13（1.85，2.46），空洞0.56（0.42，0.76），纵隔肺门淋巴结肿大2.19（1.94，2.48）和粟粒性病灶2.01（1.53，2.64）。结论 艾滋病合并肺结核的影像学表现不典型，渗出、粟粒性病灶、纵隔肺门淋巴结肿大、胸腔积液较常见而空洞较少发生。

To analyze the chest imaging features’differences between pulmonary tuberculosis patients with AIDS and pure pulmonary tuberculosis patients by using Meta-analysis,and to improve the radiologically diagnostic competence for pulmonary tuberculosis patients with AIDS.Methods A total of 13 literatures on chest imaging features differences between pulmonary tuberculosis patients with AIDS and pure pulmonary tuberculosis patients were found by retrievaling the CNKI,CQVIP,Wanfang,and PubMed.The heterogeneities of all the literatures above were tested and the relative risk(RRcombined)and 95%confidence interval(95%CI)were calculated by using Meta-analysis.Random effects model was used to analyze the pneumonic infiltrate,cavitation,and miliary disease;fixed effects model was used to analyze the hilar and/or mediastinal adenopathy and pleural effusions.Results The RRcombined(95%CI)of the main chest imaging features were pneumonic infiltrate 1.25(1.07,1.47),pleural effusions 2.13(1.85,2.46),cavitation 0.56(0.42,0.76),hilar and/or mediastinal adenopathy 2.19(1.94,2.48),and miliary disease 2.01(1.53,2.64)respectively.Conclusion The patients with pulmonary tuberculosis and AIDS are much more likely to have typical chest radiographic findings,which have more pneumonic infiltrate,miliary disease,pleural effusions,hilar and/or mediastinal adenopathy,and less cavitation.