Meta-analysis of the efficacy, adverse reactions, and fatality rate of glucocorticoid combined with anti-tuberculosis drugs in the treatment of tuberculous serositis

doi:10.19982/j.issn.1000-6621.20240497

Abstract

Abstract:

Objective: To systematically evaluate the efficacy, adverse reactions and mortality of glucocorticoids combined with anti-tuberculosis drugs in the treatment of tuberculous serositis. Methods: Randomized controlled trials (RCTs) of glucocorticoids combined with anti-tuberculosis drugs in the treatment of tuberculous serositis were retrieved from CNKI, Wanfang, VIP, China Biomedical Literature Database, PubMed and Web of Scienceby using a combination of subject words and free words, and references in research articles were included. The search period was from the establishment of the database to August 1, 2024. Chinese search terms include extra pulmonary tuberculosis, tuberculous meningitis, tuberculous pleurisy, tuberculous pericarditis, glucocorticoids, steroid hormones, dexamethasone, methylprednisolone, etc.; English search terms include tuberculosis, tuberculous meningitis, tuberculous pleurisy, tuberculous pericarditis, glucocorticoids, steroid hormones, dexamethasone, methylprednisolone, etc. Two researchers independently screened the literature, extracted the data, and evaluated the quality of the literature, and then used Stata 15.1 software to analyze the heterogeneity of the included data and analyze the publication bias to comprehensively evaluate the efficacy, adverse reactions and mortality of tuberculous serositis after glucocorticoids on the basis of anti-tuberculosis therapy. Results: A total of 4619 related literatures were retrieved.After excluding the literatures that did not meet the inclusion criteria, 31 literatures and 2410 patients were included for meta-analysis. Among them,1228 patients in the anti-tuberculosis therapy combined with glucocorticoids therapy group (experimental group) and 1182 patients in the anti-tuberculosis treatment group (control group). According to the type of disease, the patients were further divided into tuberculous meningitis group (including 23 studies, 876 cases in the experimental group and 876 cases in the control group), tuberculous pleurisy group (including 6 studies, 280 cases in the experimental group and 276 cases in the control group) and tuberculous pericarditis group (including 2 studies, 72 cases in the experimental group and 30 cases in the control group). The results of meta-analysis showed that the combination of glucocorticoids was more effective in the treatment of tuberculous meningitis, tuberculous pleurisy, and tuberculous pericarditis compared with the control group (OR(95%CI)=4.63 (3.48-6.17), 6.62 (3.55-12.34), 7.92 (2.44-25.66)), and the mortality rate against tuberculous meningitis was lower (OR (95%CI)=0.45 (0.23-0.87)), and there were fewer adverse reactions to tuberculous pleurisy (OR(95%CI)=0.31 (0.18-0.52)). Conclusion: Glucocorticoids combined with anti-tuberculosis drugs therapy can improve the efficacy of tuberculous meningitis, tuberculous pleurisy and tuberculous pericarditis, and reduce the mortality rate of tuberculous meningitis and the adverse drug reactions of tuberculous pleurisy.

Key words: Tuberculosis, Serositis, Anti-tuberculosis drugs, Glucocorticoids, Treatment outcomes, Meta-analysis (subject)

CLC Number:

Shi Yilin, Gu Yan. Meta-analysis of the efficacy, adverse reactions, and fatality rate of glucocorticoid combined with anti-tuberculosis drugs in the treatment of tuberculous serositis[J]. Chinese Journal of Antituberculosis, 2025, 47(1): 77-86. doi: 10.19982/j.issn.1000-6621.20240497

Figures/Tables 11

疾病类型/第一作者及发表年份	患者例数(观察组例数/对照组例数)	治疗方案		结局指标
疾病类型/第一作者及发表年份	患者例数(观察组例数/对照组例数)	对照组	观察组	结局指标
结核性脑膜炎
徐国光1997^[20]	88(42/46)	3H-R-E-Z/9H-R	联合甲泼尼龙500mg,5d后改为地塞米松15mg,酌情减量,总疗程3个月	①③
何宏2014^[21]	50(25/25)	3H-R-E-Z	联合甲泼尼松30mg,总疗程2个月	①
陈锋2015^[19]	160(80/80)	3H-R-E-Z/9H-R	联合甲泼尼龙500mg,静脉滴注5d后改为地塞米松15mg,静脉滴注,酌情减量,总疗程2个月	①②③
韩永峰2015^[29]	96(48/48)	H-R-E-Z	联合地塞米松10mg,静脉滴注7d后改为泼尼松40mg口服,酌情减量,总疗程3个月	①
宋庆艳2016^[14]	96(48/48)	3H-R-E-Z	联合地塞米松15mg,静脉滴注14d(病情I级患者)或联合地塞米松10mg,静脉滴注14d(病情Ⅱ级、Ⅲ级患者),总疗程3个月	①②③
李建辉2016^[28]	80(40/40)	H-R-E-Z	联合地塞米松15~20mg,静脉滴注7d,酌情减量至10mg并维持,总疗程2个月	①
徐齐峰2016^[31]	100(50/50)	H-R-E-Z	联合地塞米松10mg,静脉滴注7d,5~21d后改用泼尼松40mg口服,酌情减量,总疗程3个月	①
刘丹2017^[22]	42(21/21)	H-R-E-Z	联合地塞米松10mg,静脉滴注1个月后酌情减量,总疗程3个月	①
杨芳2017^[25]	76(38/38)	H-R-E-Z	联合甲泼尼龙500mg,静脉滴注5d后改为地塞米松,总疗程3个月	①
赵雪2017^[27]	90(45/45)	2H-R-E-Z	联合地塞米松10mg,静脉滴注7d后改为泼尼松40mg口服,总疗程2个月	①
刘洁2018^[24]	82(41/41)	H-R-E-Z	联合地塞米松15~20mg/d,静脉滴注7d后每周减2~3mg,直到剂量为10mg/d,总疗程2个月	①
张荣2018^[16]	82(41/41)	2H-RE-Z	联合地塞米松10mg,静脉滴注7d后改为泼尼松40mg口服,总疗程2个月	①②
张婷婷2019^[30]	35(17/18)	3H-R-E-Z	联合地塞米松20mg,静脉滴注,每周减少5mg。减至5mg时改为强的松30mg,口服,每周进行减量,直至无需服用,总疗程3个月	①
孔波2019^[13]	67(36/31)	2H-R-E-Z/4H-R	联合甲泼尼龙500mg,静脉滴注7d后减至维持量,总疗程3个月	①②
柯尊钰2019^[39]	50(25/25)	2H-R-E-Z	联合地塞米松10~20mg,静脉滴注14d后改为泼尼松40mg口服,总疗程2个月	①
邢俊蓬2019^[32]	60(30/30)	2H-R-E-Z/4H-R	联合甲泼尼龙500mg,静脉滴注7d后减量至80mg,酌情减量,总疗程3个月	①
刘杰2019^[23]	68(34/34)	2H-R-E-Z/4H-R	联合甲泼尼龙500mg,静脉滴注7d,减量至80mg后酌情维持3个月	①
杨楠2021^[17]	60(30/30)	2H-R-E-Z/4H-R	联合甲泼尼龙500mg,静脉滴注7d,酌情减至维持量,总疗程3个月	①②
刘钰2021^[12]	90(45/45)	2H-R-E-Z/4H-R	联合甲泼尼龙500mg,静脉滴注7d后逐渐减药,总疗程3个月	①②
谢婷2021^[26]	64(32/32)	2H-L-Z-E/4H-L-E	联合地塞米松10~20mg,静脉滴注7d后减量至10mg,总疗程2个月	①②
贺时磊2021^[18]	78(39/39)	2H-R-E-Z/4H-R	联合甲泼尼龙500mg,7d后减量至80mg,再减量至20mg,后改为甲泼尼龙片8mg口服,总疗程3个月	①②
彭蕴蕴2021^[33]	58(29/29)	H-R-E-Z	联合地塞米松10mg,静脉滴注7d,改为泼尼松30mg口服,后逐渐减量,总疗程3个月	①
宋薇2022^[15]	80(40/40)	2H-R-E-Z/4H-R	联合甲泼尼龙500mg,静脉滴注7d后改为80g/d,逐渐改为甲泼尼龙片8mg口服,总疗程3个月	①②
结核性胸膜炎
汪慧兰2011^[38]	66(32/34)	2H-R-E-Z/4HR	联合强的松30mg口服7d后减量,总疗程6周	①
刘琼2019^[35]	73(35/38)	2H-R-E-Z/4H-R	联合地塞米松5mg,抽吸胸腔积液后注射。总疗程6个月	①②
朱凤娟2019^[36]	126(63/63)	H-R-E-Z	联合地塞米松5mg,胸腔注射,总疗程3个月	①②
黄斌2020^[11]	100(50/50)	0.5H-R-E-Z	联合地塞米松注射液5mg,经胸腔引流管注射,总疗程2周	①②
闫雨2023^[40]	61(35/26)	1.5H-R-E-Z	联合泼尼松片30mg,每周减5mg,总疗程6周	①②
张欣2023^[34]	130(65/65)	H-R-E-Z	联合醋酸泼尼松片30mg口服,10d后减少10mg,20d后每10d减少5mg,总疗程3个月	①②
结核性心包炎
蔡远翔2007^[7]	56(47/9)	2H-R-E-Z/10H-R-E	联合泼尼松30mg,4周后减量,每周减前一周的1/5量,总疗程11周	①
杨梅2014^[37]	46(25/21)	2H-R-Z-E-A/1H-RE-Z/15H-R-E	联合强的松30~50mg,1个月,每周减量5mg,总疗程13周	①

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