结核后肺疾病患者患病率和影响因素的Meta分析

doi:10.19982/j.issn.1000-6621.20240454

摘要/Abstract

摘要：

目的: 评价结核后肺疾病的患病率和影响因素。 方法: 计算机检索Cochrane Library、Medline、Embase、Web of Science、CINAHL、中国知网(CNKI)、万方数据知识服务平台、维普网(VIP)和中国生物医学文献服务系统(Sinomed)中收录的结核后肺疾病患者患病率和影响因素的相关文献,中文检索词包括:“肺结核/肺痨/肺消耗/结核后”“肺部疾病/肺疾病”“影响因素/危险因素/病因/相关因素”“病例对照研究/队列研究/横断面研究”;英文检索词包括:‘tuberculosis, pulmonary/pulmonary consumption/pulmonary phthis*/post-tb/post tuberculosis’ ‘lung diseases/disease, pulmonary’ ‘factor, risk/population at risk/risk scores/health correlates/factor, social risk/risk factor scores’ ‘case-control studies/cohort studies/cross-sectional studies’,检索时限为建库至2024年9月。由两名研究者独立进行筛选、评价文献及提取信息,并用Stata 17.0软件进行整合分析。结果: 纳入12篇文献,共795890例患者。Meta分析显示,结核后肺疾病的患病率为33.2%[95%CI(12.0%~58.8%)]。受教育程度低(OR=2.32, 95%CI:1.51~3.56, P<0.001)、低体质量指数(BMI)(SMD=-0.39, 95%CI:-0.43~-0.34, P<0.001)、低收入(OR=1.19, 95%CI:1.08~1.32, P=0.001)、城市居民(OR=1.13, 95%CI:1.09~1.16, P<0.001)、并发糖尿病(OR=2.37, 95%CI:2.19~2.55, P<0.001)、并发癌症(OR=2.01, 95%CI:1.85~2.18, P<0.001)、住院次数多(SMD=0.44, 95%CI:0.25~0.63, P<0.001)是结核后肺疾病的影响因素。结论: 结核后肺疾病的影响因素众多,护理人员应针对影响因素进行预防,制定个体化干预措施,以减少结核后肺疾病的发生。

关键词: 结核, 肺, 肺疾病, 患病率, Meta分析

Abstract:

Objective: To identify the prevalence and influencing factors of post-tuberculosis lung disease. Methods: Computerized search was performed for studies on prevalence and influencing factors of post-tuberculosis lung disease in CNKI, WANFANG DATA, VIP, CBM, Cochrane Library, Medline, Embase, Web of Science and CINAHL database from the time of database establishment to September 2024. Both Chinese and English search words were ‘Tuberculosis, Pulmonary/Pulmonary Consumption/Pulmonary Phthis*/post-tb/post tuberculosis’ ‘Lung Diseases/Disease, Pulmonary’ ‘Factor, Risk/Population at Risk/Risk Scores/Health Correlates/Factor, Social Risk/Risk Factor Scores’ ‘Case-Control Studies/Cohort Studies/Cross-Sectional Studies’. Literature screening, quality assessment, and data extraction were performed independently by 2 investigators, and Meta-analysis was performed using Stata 17.0 software. Results: Twenty papers with a total of 795890 patients were included. Meta-analysis showed that the prevalence of post-tuberculosis lung disease was 33.2% (95%CI: 12.0%-58.8%). Low education level (OR=2.32, 95%CI: 1.51-3.56, P<0.001), low BMI (SMD=-0.39, 95%CI: -0.43--0.34, P<0.001), low income (OR=1.19, 95%CI: 1.08-1.32, P=0.001), urban residence (OR=1.13, 95%CI: 1.09-1.16, P<0.001), combined diabetes (OR=2.37, 95%CI: 2.19-2.55, P<0.001), combined cancer (OR=2.01, 95%CI: 1.85-2.18, P<0.001), times of hospitalization (SMD=0.44, 95%CI: 0.25-0.63, P<0.001) and other factors were influential factors for post-tuberculosis lung disease. Conclusion: There are many factors influencing post-tuberculosis lung disease, nursing staff should address the influencing factors and develop individualized interventions to reduce the occurrence of post-tuberculosis lung disease.

Key words: Tuberculosis, pulmonary, Lung diseases, Prevalence, Meta-analysis

中图分类号:

R521

宋菲尔, 毛燕君, 夏秋月, 周洋, 林欢. 结核后肺疾病患者患病率和影响因素的Meta分析[J]. 中国防痨杂志, 2025, 47(3): 322-330. doi: 10.19982/j.issn.1000-6621.20240454

Song Feier, Mao Yanjun, Xia Qiuyue, Zhou Yang, Lin Huan. The prevalence and influencing factors of post-tuberculosis lung disease: A Meta-analysis[J]. Chinese Journal of Antituberculosis, 2025, 47(3): 322-330. doi: 10.19982/j.issn.1000-6621.20240454

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序号	检索词
#1	(((((″tuberculosis, pulmonary″[Mesh]) OR (pulmonary consumptions[Title/Abstract])) OR (pulmonary phthis*[Title/Abstract])) OR (pulmonary tuberculoses[Title/Abstract])) OR (post-tb[Title/Abstract])) OR (post tuberculoses[Title/Abstract])
#2	(″lung diseases″[Mesh]) OR (disease, pulmonary[Title/Abstract])
#3	(((((″risk factors″[Mesh]) OR (population at risk[Title/Abstract])) OR (risk scores[Title/Abstract])) OR (risk factor scores[Title/Abstract])) OR (health correlates[Title/Abstract])) OR (factor, social risk[Title/Abstract])
#4	(((((″case-control studies″[Mesh]) OR (case-comp* studies[Title/Abstract])) OR (case-base studies[Title/Abstract])) OR (case-referent studies[Title/Abstract])) OR (matched case-control studies[Title/Abstract])) OR (nested case-control studies[Title/Abstract])
#5	((((((″cohort studies″[Mesh]) OR (studies, concurrent[Title/Abstract])) OR (cohort studies, closed[Title/Abstract])) OR (cohort studies, historical[Title/Abstract])) OR (incidence studies[Title/Abstract])) OR (analys*, cohort[Title/Abstract])) OR (birth cohort studies[Title/Abstract])
#6	((((″cross-sectional studies″[Mesh]) OR (cross-sectional survey[Title/Abstract])) OR (surveys, disease frequency[Title/Abstract])) OR (analys*, cross-sectional[Title/Abstract])) OR (prevalence studies[Title/Abstract])
#7	#4 OR #5 OR #6
#8	#1 AND #2 AND #3 AND #7

纳入文献	发表时间	研究地区	研究类型	研究对象	影响因素	患病率 (%)	质量评分 (分)
Kim等^[13]	2024年	韩国	队列研究	肺结核相关阻塞性肺疾病	③⑤⑧⑩ ??????	50.0	7
Wang等^[14]	2023年	中国	队列研究	肺结核相关阻塞性肺疾病	①④???	2.7	6
Shanmugasundaram等^[15]	2022年	印度	病例对照研究	肺结核病后遗症	⑤	50.0	7
Setianingrum等^[16]	2022年	印度尼西亚	队列研究	肺结核后慢性肺曲霉菌病	②	5.6	7
Park等^[17]	2022年	韩国	队列研究	肺结核相关阻塞性肺疾病	①③⑤⑧?	17.8	7
Swain等^[18]	2021年	印度	队列研究	肺结核相关阻塞性肺疾病	①②③⑤⑥⑦⑨	50.7	7
Khosa等^[19]	2020年	南非	队列研究	肺结核后肺功能损伤	②③	64.5	8
Mkoko等^[20]	2019年	南非	病例对照研究	肺结核后慢性肺部疾病	??	71.5	6
Yakar等^[21]	2017年	土耳其	队列研究	肺结核相关阻塞性肺疾病	①⑦⑨	15.0	7
Gandhi等^[22]	2016年	印度	病例对照研究	肺结核后肺功能损伤	③④⑤?	74.0	7
Nihues等^[23]	2015年	巴西	横断面	肺结核病后慢性肺部疾病	②④??	45.0	8
Yu等^[24]	2011年	中国台湾	队列研究	肺结核后肺癌	①②⑩????	0.6	7

亚组	纳入研究文献数量	异质性检验结果		效应模型	Meta分析结果
亚组	纳入研究文献数量	I²值(%)	P值	效应模型	OR(95%CI)值	P值
疾病类型
结核相关阻塞性肺疾病	5	99.958	<0.001	随机	0.243(0.066~0.484)	<0.001
其他类型疾病	7	99.671	<0.001	随机	0.401(0.078~0.783)	0.002
研究年份
2011—2019年	7	99.936	<0.001	随机	0.303(0.124~0.519)	<0.001
2020—2024年	5	99.782	<0.001	随机	0.368(0.061~0.756)	0.002

影响因素	纳入研究数	异质性检验结果		效应模型	Meta分析结果
影响因素	纳入研究数	I²值(%)	P值	效应模型	合并效应量	95%CI值	P值
一般资料
年龄	4	94.1	<0.001	随机	SMD=-0.12	(-0.50~0.25)	0.526
性别(女)	4	48.9	0.118	固定	OR=2.46	(1.20~5.04)	0.014
吸烟(是)	5	96.5	<0.001	随机	OR=0.84	(0.56~1.27)	0.413
受教育程度(低)	3	0.0	0.424	固定	OR=2.32	(1.51~3.56)	<0.001
BMI	5	0.0	0.876	固定	SMD=-0.39	(-0.43~-0.34)	<0.001
收入(低)	4	53.1	0.094	随机	OR=1.19	(1.08~1.32)	0.001
居住地(城市)	2	0.0	0.366	固定	OR=1.13	(1.09~1.16)	<0.001
并发症(是)
糖尿病	2	98.1	<0.001	随机	OR=2.01	(1.85~2.18)	<0.001
高血压	2	99.9	<0.001	随机	OR=1.60	(0.52~4.86)	0.410
血脂异常	2	99.3	<0.001	随机	OR=1.54	(0.90~2.62)	0.114
癌症	2	0.0	0.360	固定	OR=2.01	(1.85~2.18)	<0.001
不良事件
急性加重的严重程度	2	89.8	0.002	随机	OR=3.71	(0.85~16.28)	0.082
住院频率	2	0.0	0.919	固定	SMD=0.44	(0.25~0.63)	<0.001