非结核分枝杆菌肺病与肺结核临床及影像学特征Meta分析

Meta-analysis of Clinical and Imaging Features of Nontuberculous Mycobacterial Lung Disease and Tuberculosis

目的:探讨非结核分枝杆菌(NTM)肺病与肺结核的影像学特征,并分析两者之间的差异。方法:应用计算机检索中国知网(CNKI)及万方医学网等数据库,查找建库到2020年12月的肺结核与NTM肺病的病例对照文献,并进行Meta分析。对照组为肺结核患者,实验组为NTM肺病患者,观察指标主要为临床表现和影像学表现。根据纳入、排除标准,对文献质量进行评价,并提取相应数据进行meta分析。结果:根据本研究的预定标准,最终纳入文献15篇,共包括2067例患者(NTM肺病患者919例,肺结核患者1148例)。结果表明,与肺结核组相比,NTM肺病组发热发生率降低[OR(95%CI):0.68(0.48~0.96)],咯血发生率升高[OR(95%CI):2.09(1.14~3.01)];咳嗽发生率比较,两组差异无统计学意义[OR(95%CI):1.52(0.81~2.85)]。与肺结核组相比,NTM肺病组支气管扩张、薄壁空洞发生率升高[OR(95%CI):3.84(2.46~6.01)、1.61(1.08~2.40)];病变累及1~2个肺叶、淋巴结钙化、淋巴结肿大、厚壁空洞发生率降低[OR(95%CI):0.47(0.33~0.66)、0.30(0.20~0.43)、0.44(0.25~0.77)、0.55(0.38~0.80)]。病变累及5~6个肺叶、病变累及3~4个肺叶、胸膜增厚发生率比较,两组差异无统计学意义[OR(95%CI):1.42(0.66~3.04)、0.73(0.50~1.05)、1.30(0.62~2.75)]。结论:NTM肺病的临床表现和影像学特征与肺结核类似,对于有上述临床特征及影像学特点,且抗结核治疗效果不佳的疾病,应考虑NTM肺病的可能。

Objective:To investigate the imaging features of nontuberculous mycobacterial(NTM)lung disease and tuberculosis,and analyze the differences between them.Methods:The databases of china knowledge network(CNKI)and Wanfang medical network were searched by computer to find the case-control literature of tuberculosis and NTM lung disease from the establishment of the database to December 2020,and meta-analysis was carried out.The control group was tuberculosis patients,and the experimental group was NTM lung disease patients.The observation indications were mainly clinical and imaging findings.According to the inclusion and exclusion criteria,the literature quality was evaluated,and the corresponding data were extracted for meta-analysis.Results:According to the predetermined criteria of this study,15 articles were finally included,including 2067 patients(919 NTM lung disease patients and 1148 tuberculosis patients).The final results showed that compared with the tuberculosis group,the incidence of fever in the NTM lung disease group was lower[OR(95%CI):0.68(0.48~0.96)],and the incidence of hemoptysis[OR(95%CI):2.09(1.14~3.01)]was higher;the incidence of cough was not statistically difference between the two groups[OR(95%CI):1.52(0.81~2.85)].Compared with the group of tuberculosis,the NTM lung disease group had bronchiectasis and thin-walled cavities incidence increased[OR(95%CI):3.84(2.46~6.01),1.61(1.08~2.40)];the incidence of lesion involving 1~2 lung lobes,lymph node calcification,lymph node enlargement and thick wall cavity decreased[OR(95%CI):0.47(0.33~0.66),0.30(0.20~0.43),0.44(0.25~0.77),0.55(0.38~0.80)].There was no significant difference between the two groups in the incidence of lesion involving 5~6 lung lobes,lesion involving 3~4 lung lobes and pleural thickening[OR(95%CI):1.42(0.66~3.04),0.73(0.50~1.05),1.30(0.62~2.75)].Conclusion:The clinical and imaging features of nontuberculous mycobacterial lung disease are similar to those of tuberculosis.When there are clinical and imaging features as described above and the anti-tuberculosis treatment is not effective,the possibility of NTM lung disease should be considered.