关键词: 尘肺, 分枝杆菌感染, 健康调查, 因素分析,统计学, Meta分析

Abstract:

Objective: To systematically evaluate the current epidemiological status and its risk factors of latent tuberculosis infection (LTBI) among pneumoconiosis patients, aiming to provide a reference for the formulating and improving prevention, control and management strategies for pneumoconiosis complicated wth tuberculosis. Methods: A systematic search was conducted using a combination of subject headings and free-text terms to identify Chinese and English-language research literature on pneumoconiosis complicated with LTBI from database inception to October 2025. Databases included CNKI, Wanfang, VIP, PubMed, the Cochrane Library and Web of Science. Following inclusion and exclusion criteria, a preliminary screening was performed based on titles and abstracts, followed by a re-screening through full-text review. Finally, relevant information was extracted from eligible studies. A random-effects model was employed to conduct meta-analysis, sensitivity analysis and subgroup analysis (by study type, region, location, population and type of pneumoconiosis) of LTBI prevalence, and to summarize and analyze factors associated with LTBI prevalence. Results: Following keyword searching, initial screening of titles and abstracts, and full-text re-screening, a total of nine studies were ultimately included, comprising eight Chinese studies and one German study. All studies utilized a Mycobacterium tuberculosis-specific quantitative interferon-gamma enzyme-linked immunosorbent assay (ELISA) to detect LTBI in the pneumoconiosis population. The LTBI prevalence varied considerably across studies (excluding one German study), ranging from 4.11% to 66.4%, with high heterogeneity (I²=94.00%, 95%CI: 90.37%-96.26%, P<0.001). The pooled LTBI prevalence was 44.69% (95%CI: 26.27%-64.69%). In the sensitivity analysis, after excluding studies with extreme LTBI prevalence and those with small sample sizes, respectively, high heterogeneity persisted across studies (I²=89.28%, 95%CI: 80.42%-94.13%, P<0.001; I²=94.65%, 95%CI: 91.24%-96.73%, P<0.001). In the subgroup analysis, heterogeneity was reduced in studies focusing on silicosis and coal worker’s pneumoconiosis, but statistical heterogeneity persisted in both (I²=86.05%, 95%CI: 59.52%-95.20%, P<0.001; I²=65.18%, 95%CI: 0.00%-90.00%, P=0.056). However, heterogeneity among studies on other types of pneumoconiosis significantly reduced after excluding studies with extreme LTBI prevalence (I²=48.07%, 95%CI: 0.00%-82.79%, P=0.123). Occupational factors (occupation type, workplace ventilation, type of dust exposure and duration of exposure), personal behaviors, lifestyle (smoking, alcohol consumption and dietary nutritional status), and social factors were associated with LTBI in the pneumoconiosis population. Conclusion: The prevalence of LTBI in pneumoconiosis patients is significantly higher than that in the general population; however, the LTBI prevalence varies considerably across studies, and the infection rate is influenced by occupational, personal behaviors and lifestyle habits, and social factors, future research should prioritize multi-center, prospective cohort studies to investigate key risk factors for LTBI in pneumoconiosis patients, thereby facilitating the development of more targeted interventions.

Key words: Pneumoconiosis, Mycobacterium infections, Health surveys, Factor analysis, statistics, Meta-analysis