移动医疗技术在结核病患者健康管理中应用效果的Meta分析

doi:10.19982/j.issn.1000-6621.20250227

摘要/Abstract

摘要：

目的: 系统评价移动医疗技术在结核病患者健康管理中的应用效果,为临床实践提供参考依据。方法: 计算机系统检索Web of Science、Embase、Cochrane Library、PubMed、CINAHL、中国生物医学文献数据库、中国知网、万方数据库、维普数据库中收录的基于移动医疗技术在结核病患者健康管理中应用效果的随机对照试验。检索时限为建库至2025年5月30日。由2名研究者独立进行文献筛选、数据提取及质量评价,采用RevMan 5.4及Stata 16.0软件进行Meta分析。结果: 共纳入10篇文献,5615例患者。Meta分析结果显示,使用移动医疗技术对结核病患者进行健康管理后,观察组治疗依从率(RR=1.20,95%CI:1.12~1.29,P<0.001)、治疗成功率(RR=1.09,95%CI:1.03~1.16,P=0.006)、痰检率(RR=1.14,95%CI:1.06~1.22,P<0.001)均高于对照组,差异均有统计学意义;两组不良结局发生率比较,观察组低于对照组,差异有统计学意义(RR=0.75,95%CI:0.59~0.96,P=0.020)。亚组分析显示,与信息提醒及电子药盒比较,采用微信程序(RR=1.28,95%CI:1.17~1.40,P<0.001)及手机视频(RR=1.29,95%CI:1.13~1.46,P<0.001)干预形式的患者治疗依从率均较高,差异均有统计学意义;与医院-社区、医院-家庭干预模式比较,采用医院-社区-家庭干预模式的患者治疗依从率高,差异有统计学意义(RR=1.24,95%CI:1.16~1.33,P<0.001);与干预时长≤3个月比较,干预时长>3个月的患者治疗依从率高,差异有统计学意义(RR=1.23,95%CI:1.19~1.27,P<0.001)。结论: 实施移动医疗技术能提升结核病患者治疗依从率、治疗成功率、痰检率,降低不良结局发生率。可运用微信小程序及手机视频等实时互动强的移动医疗技术、采用医院-社区-家庭联动模式、延长干预时间、根据移动医疗技术使用影响因素进行干预方案构建,进一步提升干预效果。

关键词: 结核, 计算机通信网络, Meta分析, 护理

Abstract:

Objective: To systematically evaluate the application effect of mobile medical technology in tuberculosis patient health management, to provide reference for clinical practice. Methods: A systematic search of Web of Science, Embase, Cochrane Library, PubMed, CINAHL, CBM, CNKI, WanFang Data and VIP database was conducted for randomised controlled trials about mobile medical technology’s usage on tuberculosis patient health management. The retrieval time limit was from database establishment to May 30, 2025. Two researchers independently screened literature,extracted data and evaluated quality. Meta-analysis was performed using RevMan 5.4 and Stata 16.0 software. Results: A total of 10 articles and 5615 patients were included. Meta-analysis showed that after applying mobile medical technology for the health management of tuberculosis patients, treatment compliance rate (RR=1.20,95%CI:1.12-1.29,P<0.001), treatment success rate (RR=1.09,95%CI:1.03-1.16,P=0.006), and sputum examination rate (RR=1.14,95%CI:1.06-1.22,P<0.001) of the observation group were all statistically significantly higher than those of the conventional group. Adverse outcomes occurrence in the observation group was significantly lower than that of the conventional group (RR=0.75,95%CI:0.59-0.96,P=0.020). Subgroup analysis showed that compared with information reminders and electronic pill boxes, patients who received intervention through WeChat program (RR=1.28,95%CI:1.17-1.40, P<0.001) and mobile face-to-face video (RR=1.29,95%CI:1.13-1.46,P<0.001) had significantly higher treatment compliance rates; compared with hospital-community and hospital-family intervention models, patients took hospital-community-family intervention model had significantly higher treatment compliance rate (RR=1.24,95%CI:1.16-1.33,P<0.001); compared with an ≤3 months intervention, patients getting intervention >3 months had significantly higher treatment compliance rate (RR=1.23,95%CI:1.19-1.27,P<0.001). Conclusion: The implementation of mobile medical technology can improve treatment compliance rate, treatment success rate and sputum examination rate of tuberculosis patients, and reduce incidence of adverse outcomes. Mobile medical technology with strong real-time interaction such as WeChat and mobile video can be used, together with adopting hospital-community-family linkage mode, extending intervention time, constructing intervention plan according to factors influencing usage of mobile medical technology, to further improve the intervention effect.

Key words: Tuberculosis, Computer communication networks, Mate-analysis, Nursing care

中图分类号:

高丹, 姚丽伟, 黄金鹏, 刘晓霞, 张玥, 凌琳. 移动医疗技术在结核病患者健康管理中应用效果的Meta分析[J]. 中国防痨杂志, 2025, 47(11): 1433-1441. doi: 10.19982/j.issn.1000-6621.20250227

Gao Dan, Yao Liwei, Huang Jinpeng, Liu Xiaoxia, Zhang Yue, Ling Lin. Application effect of mobile medical technology in health management of tuberculosis patients: A Meta-analysis[J]. Chinese Journal of Antituberculosis, 2025, 47(11): 1433-1441. doi: 10.19982/j.issn.1000-6621.20250227

图/表 10

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纳入文献的基本特征

纳入文献	发表年份	国家	观察组患者例数/对照组患者例数	对照组干预措施	观察组干预措施		干预模式	干预时长 (月)	结局指标	移动医疗使用影响因素
纳入文献	发表年份	国家	观察组患者例数/对照组患者例数	对照组干预措施	干预形式	干预方法	干预模式	干预时长 (月)	结局指标	移动医疗使用影响因素
Bao等^[8]	2022	中国	53/59	常规护理	微信平台	基于健康行为改变理论进行知识教育、自我调节、社会支持	医院-家庭	3	a	整合行为理论、有用性、易用性
Gashu等^[9]	2021	埃塞俄比亚	152/154	社区支持者观察	信息提醒	每日用药、每周取药图文提醒	医院-社区-家庭	4	a、b	多模态提醒系统、消除阅读障碍
Iribarren等^[10]	2022	阿根廷	21/21	常规护理	手机程序	每日服药自我报告、不良反应跟踪、治疗进度日历、论坛	医院-家庭	6	b	技术可行性、易用性、多模态监测、系统性支持
Kumwichar 等^[11]	2022	泰国	57/57	面对面督导治疗	手机视频	记录并上传服药视频,监测服药情况	医院-社区	2	c、f、g	网络覆盖率、医护执行力、政策支持
Liu等^[12]	2023	中国	1388/1298	常规护理	电子药盒	每月服药依从性数据审查、分级管理	医院-家庭	6	c、g	情境适配、技术可行性
Qin等^[13]	2025	中国	371/370	标准护理	微信小程序	用药提醒、随访提醒、医患实时沟通平台、个性化健康教育推送、未服药警报系统	医院-社区-家庭	6	c、f、g	健康信念模型、社会认知理论、实时交互与数据驱动管理
Santra等^[14]	2021	印度	110/110	标准督导	信息提醒	每日短信提醒、每周电话沟通:健康教育、服药提醒	医院-社区	3	d	技术接受度、文化适配性和成本可持续性
张小其等^[15]	2022	中国	108/108	定期入户访视	手机视频	上传服药视频,监测服药情况	医院-社区-家庭	6	b、d、h	实时互动反馈、便利性、数据隐私、安全与伦理
张婷等^[16]	2017	中国	74/74	常规护理	微信公众号	每周2~3次推送结核病防治知识(文字/图片/语音/视频)、每日2个时段在线答疑	医院	6	f、h、i	可行性、内容全面性、互动支持、定期推送、固定管理时段
李亚敏等^[17]	2023	中国	515/515	常规护理	微信、电子药盒	微信签到、电子药盒自动上传服药数据	医院-社区-家庭	8	e、f、i	技术接受度与满意度

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图7

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步骤	检索式
#1	(″Tuberculosis″[Mesh]) OR (“Tuberculosis*”OR“Phthisis”OR“Pulmonary Tuberculosis”OR“Extrapulmonary Tuberculosis”)
#2	(″Health Information Management″[Mesh]) OR (“Health Management*”OR“Medication Management”OR “Follow-up Mana-gement”OR“Adherence”OR“Self-management”OR“Hospital Management”OR“Continuing Care”OR“Follow-up”OR“Community Management”OR“Home Management”OR“Family Management”OR“Health Education”OR“Remote Care”)
#3	(″Telemedicine″[Mesh]) OR (“mHealth”OR“Mobile Health”OR“Internet of Things”OR“Intelligent Medical Devices”OR“Telemedicine”OR“Remote Health”OR“eHealth”OR“Applications”OR“App”OR“Internet”OR“WeChat”OR“Short Messages”OR“Wearable Devices”)
#4	#1 AND #2 AND #3

亚组	文献数量 (篇)	RR (95%CI)值	异质性检验			双尾检验
亚组	文献数量 (篇)	RR (95%CI)值	χ²值	P值	I²值(%)	Z值	P值
干预方式
微信程序	2	1.28(1.17~1.40)	0.65	0.420	0	5.430	<0.001
信息提醒	2	1.13(1.04~1.22)	3.58	0.060	72	2.930	0.003
手机视频	2	1.29(1.13~1.46)	0.63	0.430	0	3.770	<0.001
电子药盒	1	1.22(1.17~1.27)	-	-	-	10.210	<0.001
干预模式
医院-社区	2	1.13(1.03~1.25)	5.41	0.020	82	2.610	0.009
医院-家庭	2	1.22(1.18~1.27)	1.03	0.310	3	10.410	<0.001
医院-社区-家庭	3	1.24(1.16~1.33)	0.46	0.800	0	6.370	<0.001
干预时长(月)
≤3	3	1.19(1.07~1.31)	12.74	0.002	84	3.330	<0.001
>3	4	1.23(1.19~1.27)	0.69	0.880	0	11.990	<0.001