摘要
目的通过荟萃分析探索我国耐多药结核病发生的主要危险因素,为耐多药结核病的预防控制提供循证依据。方法检索英文数据库Pubmed、Web of Science和中文数据库中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献服务系统,严格按照纳入和排除标准筛选文献,对纳入研究进行质量评价并提取数据资料,根据异质性大小采用随机效应模型或者固定效应模型合并效应值,同时进行敏感性分析和发表偏倚检验。结果本研究共纳入59篇文献,荟萃分析结果显示40岁及以上(OR=1.27,95%CI:1.05~1.54)、文化程度低(OR=1.29,95%CI:1.02~1.65)、痰涂片阳性(OR=2.56,95%CI:1.09~6.04)、肺腔空洞(OR=1.99,95%CI:1.57~2.52)、病程长(OR=4.25,95%CI:1.95~9.30)、结核病治疗史(OR=6.42,95%CI:5.40~7.63)、治疗中断(OR=2.81,95%CI:1.50~5.29)、不规律服药(OR=5.02,95%CI:2.95~8.54)、药物不良反应(OR=4.27,95%CI:2.22~8.19)、合并慢性阻塞性肺疾病(OR=2.21,95%CI:1.45~3.37)、结核病患者接触史(OR=1.99,95%CI:1.36~2.91)、吸烟史(OR=1.35,95%CI:1.09~1.66)、流动人口(OR=1.60,95%CI:1.04~2.44)与耐多药结核病的发生相关。结论农民、文化程度较低、肺腔空洞、病程较长、结核病治疗史、治疗中断、不规律服药、药物不良反应、合并慢性阻塞性肺疾病、结核病患者接触史、吸烟史、农村居住地以及流动人口是耐多药结核病发生的危险因素。应重视高危人群,加强管理并采取有效的措施如早期筛查、抗结核知识教育、标准化和个性化的治疗方案以及全程监督等。
Objective To explore the main risk factors of multidrug-resistant tuberculosis(MDR-TB)in China and to provide evidence-based evidence for MDR-TB preventon and control.Methods All relevant literatures were searched in thedatabases,such as Pubmed,Web of Science and CNKI,Wanfang,VIP and SinoMed from 2000 to 2021.Quality evaluation and data extraction were carried out,and then a meta-analysis was performed using Stata 16.0 software.Results A total of 59 literatures(36 cross-sectional and 23 case-control)including 75793 participants were included in this study,and meta-analysis results showed age(OR=1.27,95%CI:1.05-1.54),education level(OR=1.29,95%CI:1.02-1.65),positive sputum smear(OR=2.56,95%CI:1.09-6.04),pulmonary cavity(OR=1.99,95%CI:1.57-2.52),course of disease(OR=4.25,95%CI:1.95-9.30),history of tuberculosis treatment(OR=6.42,95%CI:5.40-7.63),treatment interruption(OR=2.81,95%CI:1.50-5.29),irregular medication(OR=5.02,95%CI:2.95-8.54),adverse drug reactions(OR=4.27,95%CI:2.22-8.19),combined chronic obstructive pulmonary disease(COPD)(OR=2.21,95%CI:1.45-3.37),tuberculosis exposure history(OR=1.99,95%CI:1.36-2.91),smoking history(OR=1.35,95%CI:1.09-1.66)and floating population(OR=1.60,95%CI:1.04-2.44)were associated with the occurrence of MDR-TB.Conclusions The high risk groups were farmer,low education level,pulmonary cavity,long course of disease,history of tuberculosis treatment,treatment interruption,irregular medication,adverse drug reaction,co-COPD,contact history of tuberculosis,smoking history,rural residence,and floating population.We should pay attention to high-risk groups,strengthen management and take effective measures such as early screening,knowledge education on tuberculosis,standardized and personalized treatment and whole-course supervision.
作者
魏淑淑
高琦
曹云贤
韩璐怿
杜建
李亮
李秀君
Wei Shushu;Gao Qi;Cao Yunxian;Han Luyi;Du Jian;Li Liang;Li Xiujun(Department of Biostatistics,School of Public Health,Cheeloo College of Medicine,Shandong University,Jinan 250012,China;Clinical Center on TB,Beijing Chest Hospital,Capital Medical University,Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China)
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2022年第12期1221-1230,共10页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
结核病
耐多药
危险因素
META分析
Tuberculosis,multidrug-resistant
Risk factors
Meta-Analysis
