中国耐多药结核病发病危险因素的Meta分析

Risk factors of multidrug-resistant tuberculosis in China:A meta-analysis

目的系统评价中国发生耐多药结核病(MDR-TB)的主要危险因素并进行分析,为我国提供有效预防MDR-TB的措施,达到病因预防(一级预防)的目的.方法时间限定为2005年1月至2019年5月,在英文数据库(PubMed、Embase、Web of Science、Cochrane Library)和中文数据库(中国知网、万方、中国生物医学文献服务系统与维普)检索中国耐多药结核病发病危险因素的相关论文,经过对论文的筛选、提取资料和质量评价后进行Meta分析.结果根据检索结果、入选及排除标准,共纳入55篇论文,通过Meta分析,发现MDR-TB相关的危险因素有9种.结果显示外省户籍人口(OR=1.92;95%CI=1.48~2.51)、家庭收入低下(OR=2.12;95%CI=1.72~2.63)、患者分类为复治患者(OR=6.28;95%CI=4.72~8.36)、既往有抗结核药物治疗史(OR=5.73;95%CI=4.56~7.20)、既往抗结核药物治疗史次数≥2次(OR=4.41;95%CI=3.35~5.80)、药物不良反应(OR=4.89;95%CI=2.48~9.62)、中断治疗(OR=3.59;95%CI=2.02~6.38)、肺部空洞(OR=1.56;95%CI=1.25~1.93)和吸烟(OR=1.59;95%CI=1.12~2.25)与MDRTB的发病密切相关.结论中国MDR TB的发病危险因素可能为外地人口、家庭收入低下、复治患者、既往抗结核治疗史、既往抗结核治疗史次数≥2次、药物不良反应、中断治疗、肺部空洞和吸烟史.

Objective This study systematically evaluated the risk factors for multidrug-resistant tuberculosis(MDR-TB)in China,which could provide an effective prevention and control strategy,and achieve the purpose of cause prevention(primary prevention).Methods The articles related to the risk factors of MDR-TB which published from January,2005 to May,2019 were searched in English databases(PubMed,Embase,Web of Science,Cochrane Library)and Chinese databases(China National Knowledge Internet,Wanfang,SinoMed and VIP database),and then meta-analysis was performed following the screening,extracting data and quality evaluation of the articles.Results According to the search results and inclusion and exclusion criteria,a total of 55 articles were included,and 9 risk factors related to MDR-TB were found by meta-analysis.The results showed that the migrant population(OR=1.92;95%CI=1.48-2.51),low household income(OR=2.12;95%CI=1.72-2.63),re-treatment(OR=6.28;95%CI=4.72-8.36),anti-tuberculosis treatment history(OR=5.73;95%CI=4.56-7.20),anti-tuberculosis treatment history≥2 times(OR=4.41;95%CI=3.35-5.80),adverse drug reactions(OR=4.89;95%CI=2.48-9.62),treatment interruption(OR=3.59;95%CI=2.02-6.38),lung cavity(OR=1.56;95%CI=1.25-1.93)and smoking(OR=1.59;95%CI=1.12-2.25)were closely related to the pathogenesis of MDR-TB.Conclusion The risk factors for MDR-TB in China are possibly migrant population,low household income,re-treatment,anti-tuberculosis treatment history,anti-tuberculosis treatment history≥2 times,adverse reactions,treatment interruption,lung cavities and smoking.