Risk factors for pulmonary tuberculosis recurrence, relapse and reinfection: a systematic review and meta-analysis.
Risk factors for pulmonary tuberculosis recurrence, relapse and reinfection: a systematic review and meta-analysis.
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肺结核复发、复发和再感染的危险因素：系统评价和荟萃分析。
DOI：
10.1136/bmjresp-2023-002281
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发表时间：
2024
影响因子：
4.1
通讯作者：
VanderStuyft,Patrick
中科院分区：
文献类型：
--
作者：
Vega,Victor;Cabrera-Sanchez,Javier;Rodríguez,Sharon;Verdonck,Kristien;Seas,Carlos;Otero,Larissa;VanderStuyft,Patrick
背景肺结核（TB）的复发率很高.识别风险因素可以支持预防策略的制定。MethodsWe检索了1980年1月1日至2022年12月31日期间发表的研究，这些研究评估了与未分化结核复发、复发或再感染相关的因素。对于至少四项研究中报告的因素，我们进行了随机效应荟萃分析，以估计合并相对风险（RR）。我们评估异质性，风险的出版偏见和确定性的evidence.ResultsWe包括85项研究中的审查; 81个记录的风险因素未分化复发，复发和10个再感染。由于研究的因素种类繁多，混杂因素控制不一致，以及只有少数研究采用分子基因分型，荟萃分析的范围有限。显著导致合并风险中度或强烈增加且证据确定性评分至少为中度的因素为：未分化复发、多药耐药（MDR）（RR 3.49; 95% CI 1.86 - 6.53）和固定剂量复方结核药物（RR 2.29; 95% CI 1.10 - 4.75）;复发，无;再感染，HIV感染（RR 4.65; 95% CI 1.71 - 12.65）。低坚持治疗复发的合并风险增加3.3倍（95%CI 2.37至4.62），但证据的确定性weak.ConclusionThis审查强调需要标准化的方法，结核病复发研究。积极开展MDR预防，促进治疗保留，并为艾滋病毒感染者提供综合护理，可以遏制复发率。在现场条件下使用结核病药物的固定剂量组合值得进一步关注。
BackgroundThe rate of pulmonary tuberculosis (TB) recurrence is substantial. Identifying risk factors can support the development of prevention strategies.MethodsWe retrieved studies published between 1 January 1980 and 31 December 2022 that assessed factors associated with undifferentiated TB recurrence, relapse or reinfection. For factors reported in at least four studies, we performed random-effects meta-analysis to estimate a pooled relative risk (RR). We assessed heterogeneity, risk of publication bias and certainty of evidence.ResultsWe included 85 studies in the review; 81 documented risk factors for undifferentiated recurrence, 17 for relapse and 10 for reinfection. The scope for meta-analyses was limited given the wide variety of factors studied, inconsistency in control for confounding and the fact that only few studies employed molecular genotyping. Factors that significantly contributed to moderately or strongly increased pooled risk and scored at least moderate certainty of evidence were: for undifferentiated recurrence, multidrug resistance (MDR) (RR 3.49; 95% CI 1.86 to 6.53) and fixed-dose combination TB drugs (RR 2.29; 95% CI 1.10 to 4.75) in the previous episode; for relapse, none; and for reinfection, HIV infection (RR 4.65; 95% CI 1.71 to 12.65). Low adherence to treatment increased the pooled risk of recurrence 3.3-fold (95% CI 2.37 to 4.62), but the certainty of evidence was weak.ConclusionThis review emphasises the need for standardising methods for TB recurrence research. Actively pursuing MDR prevention, facilitating retention in treatment and providing integrated care for patients with HIV could curb recurrence rates. The use of fixed-dose combinations of TB drugs under field conditions merits further attention.PROSPERO registration numberCRD42018077867.