中国耐多药结核病发病危险因素的Meta分析

doi:10.3969/j.issn.1000-6621.2019.12.011

摘要/Abstract

摘要：

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MDR-TB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。

关键词: 中国, 结核,抗多种药物性, 危险因素, Meta分析(主题)

Abstract:

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.

Key words: China, Tuberculosis,multidrug-resistant, Risk factors, Meta-analysis as topic

许金红,杨松,张立新,钟颖,邱倩. 中国耐多药结核病发病危险因素的Meta分析[J]. 中国防痨杂志, 2019, 41(12): 1301-1309. doi: 10.3969/j.issn.1000-6621.2019.12.011

Jin-hong XU,Song YANG,Li-xin ZHANG,Ying ZHONG,Qian QIU. Risk factors of multidrug-resistant tuberculosis in China: A meta-analysis[J]. Chinese Journal of Antituberculosis, 2019, 41(12): 1301-1309. doi: 10.3969/j.issn.1000-6621.2019.12.011

图/表 13

图1

表1

纳入文献的基本信息和NOS评分

作者	发表年份	MDR-TB (例)	非MDR-TB (例)	纳入因素	NOS评分
Yang 等^[2]	2018	176	2797	与结核病患者接触史、药物治疗次数	6
徐莉娟和刘华^[3]	2018	22	298	抗结核药物治疗史	6
杨安文等^[4]	2018	1888	7969	性别、户籍、抗结核药物治疗史	6
Sun等^[5]	2017	227	225	药物治疗次数	7
Tan等^[6]	2017	74	95	户籍、家庭经济状况、与结核病患者接触史、吸烟	7
Peng等^[7]	2017	991	11211	药物治疗次数	6
Lv等^[8]	2017	359	3118	抗结核药物治疗史	6
Wu 等^[9]	2017	47	889	性别、抗结核药物治疗史	7
Li 等^[10]	2016	325	613	抗结核药物治疗史、肺部空洞	6
余述凤等^[11]	2016	83	98	户籍、家庭经济状况、药物治疗次数、不良反应、中断治疗、肺部空洞、吸烟	6
Huai等^[12]	2016	186	171	性别、户籍、家庭经济状况	8
Zhang等^[13]	2016	287	291	性别、抗结核药物治疗史、与结核病患者接触史、吸烟	7
陈森林等^[14]	2016	163	329	性别、药物治疗次数、与结核病患者接触史、不良反应、中断治疗、吸烟	5
高春景等^[15]	2016	105	718	性别、户籍	6
汪清雅等^[16]	2016	67	67	与结核病患者接触史	9
刘慧梅等^[17]	2016	60	120	不良反应、中断治疗、肺部空洞、吸烟	8
周群博等^[18]	2016	280	4991	性别、户籍	6
Zhao 等^[19]	2015	38	230	性别、户籍、肺部空洞、与结核病患者接触史	6
韩珍等^[20]	2015	130	110	户籍	6
刘荣梅等^[21]	2015	70	199	吸烟	5
朱倬敏^[22]	2015	120	120	户籍、抗结核药物治疗史、中断治疗	8
韦余东等^[23]	2015	99	73	不良反应、吸烟	8
作者	发表年份	MDR-TB (例)	非MDR-TB (例)	纳入因素		NOS评分
宋其生等^[24]	2015	104	606	药物治疗次数、肺部空洞		5
刘泓等^[25]	2015	20	188	性别、户籍、吸烟		5
高会霞等^[26]	2015	52	249	中断治疗、吸烟		6
李莉等^[27]	2015	253	3361	性别		5
魏淑贞等^[28]	2015	45	178	性别、药物治疗次数		5
Yang 等^[29]	2015	138	280	户籍、吸烟		6
Jiao 等^[30]	2015	22	45	性别、抗结核药物治疗史、与结核病患者接触史		6
Li 等^[31]	2015	110	110	户籍		7
赵锦明等^[32]	2014	51	235	性别、户籍、药物治疗次数		6
Wang 等^[33]	2014	61	50	户籍、不良反应、吸烟		7
黄曙海等^[34]	2013	68	359	性别、户籍、药物治疗次数		5
Chen 等^[35]	2013	98	83	性别、户籍、肺部空洞、不良反应		8
Liu等^[36]	2013	88	924	性别、户籍、抗结核药物治疗史		5
Chien 等^[37]	2013	178	1912	性别、肺部空洞		5
Wang 等^[38]	2013	175	2009	性别、药物治疗次数		5
张玉等^[39]	2013	345	345	户籍、抗结核药物治疗史、与结核病患者接触史、中断治疗		8
邵燕等^[40]	2013	34	226	性别、户籍		6
陆伟等^[41]	2013	117	643	户籍、抗结核药物治疗史		6
Liang等^[42]	2012	241	1754	性别、抗结核药物治疗史、肺部空洞		5
徐吉英等^[43]	2012	23	264	性别、与结核病患者接触史、中断治疗		5
陈亮等^[44]	2012	377	433	性别、户籍、中断治疗		5
宁柱等^[45]	2012	25	209	性别、药物治疗次数		5
Shao等^[46]	2011	303	1521	性别、抗结核药物治疗史、吸烟		6
Wang等^[47]	2011	41	477	抗结核药物治疗史		5
吴兰香^[48]	2011	87	87	肺部空洞、与结核病患者接触史		7
王海东等^[49]	2011	241	1754	性别、药物治疗次数		6
He 等^[50]	2011	100	97	性别、肺部空洞、与结核病患者接触史		5
许丽等^[51]	2010	39	626	户籍		5
Shen 等^[52]	2009	333	7018	性别、户籍、抗结核药物治疗史、肺部空洞		5
王介营等^[53]	2009	25	402	肺部空洞		7
朱建福等^[54]	2009	13	82	性别、抗结核药物治疗史、与结核病患者接触史		5
Law 等^[55]	2008	156	322	户籍		7
陆兰英等^[56]	2005	100	200	抗结核药物治疗史		7

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