摘要
目的分析肺结核患者的耐药性与其家庭接触者的结核潜伏感染和发病风险的关系,探讨耐药结核分枝杆菌的补偿性突变是否会使其致病性或传播能力增强。方法计算机检索PubMed、Web of Science、Embase、Cochrane Library数据库、中国知网(CNKI)、万方数据库等中英文数据库,检索时间为建库至2022年1月,按照纳入与排除标准检索和筛选关于比较耐药和敏感肺结核患者的密切接触者的感染和发病风险情况的相关文献,提取资料,利用Newcastle-Ottawa Scale(NOS)文献质量评价量表评价文献质量,利用Stata 16.0软件进行Meta分析。结果本研究共纳入7篇文献,涉及肺结核指示病例9653名及其家庭接触者29734名。Meta分析结果显示,与药物敏感肺结核患者相比,耐药肺结核患者的家庭接触者结核感染风险增加(OR=1.56,95%CI=1.25~1.96,P<0.001),但发病风险无差异(RR=1.06,95%CI=0.80~1.41,P=0.67>0.05)。亚组分析结果显示,研究地区对家庭接触者的结核感染风险有影响,家庭接触者样本量大小对其结核病的发病风险有影响。敏感性分析表明,Meta分析结果稳健性良好。结论耐药肺结核患者的家庭接触者的结核潜伏性感染风险比药物敏感肺结核患者的家庭接触者更高,但两组家庭接触者的结核病发生风险没有差异。
Objective To analyze the association between drug resistance and the risk of latent tuberculosis infection and disease among household contacts of patients with pulmonary tuberculosis,and to explore whether the compensatory mutation of drug-resistant Mycobacterium tuberculosis will enhance its pathogenicity or transmission ability.Methods The English and Chinese databases,including Pub Med,web of science,EMBASE,Cochrane library database,CNKI and Wanfang database,were searched by computer from the time of establishment of the database to January 2022.Cohort studies on the risk of infection and disease among household contacts of patients with drug-resistant and sensitive pulmonary tuberculosis weresearched and screened according to the inclusion and exclusion criteria.The data were extracted and evaluated by NOS scale,using stata16.0 software meta-analysis to calculate the combined effect of tuberculosis infection and disease risk of familycontacts,and carry out heterogeneity test,subgroup analysis and sensitivity analysis.Results A total of 7 cohort studiesinvolving 9653 TB index cases and 29,734 house contacts were included.The results of meta-analysis showed that comparedwith drug-sensitive pulmonary tuberculosis patients,the risk of tuberculosis infection in house contacts of drug-resistantpulmonary tuberculosis patients was increased(OR=1.56,95%CI=1.25-1.96,P<0.001),but there was no difference in the riskof incidence(RR=1.06,95%CI=0.80-1.41,P=0.67>0.05).Subgroup analysis showed that the risk of latent tuberculosis infection in house contacts was affected by the study area,and the size of family contacts had an impact on the risk of TB.Sensitivity analysis showed that the results of meta-analysis were robust.Conclusion Compared with drug sensitive TB patients,household contacts with drug-resistant TB patients had a higher risk of tuberculosis,but there was no difference in the risk of TB among the two groups.
作者
张大卫
王荣
胡彩红
苗瑞芬
许可
刘夏
杨晨
江燕
朱正平
ZHANG Da-wei;WANG Rong;HU Cai-hong;MIAO Rui-fen;XU Ke;LIU Xia;YANG Chen;JIANG Yan;ZHU Zheng-ping(Nanjing Center for Disease Control and Prevention,Nanjing 210003.China)
出处
《中国热带医学》
CAS
2022年第9期844-849,共6页
China Tropical Medicine
基金
南京市重点专科项目(No.10)
南京市医学重点科技发展项(No.ZKX19050)。
关键词
结核病
耐药结核分枝杆菌
家庭接触者
结核潜伏感染
META分析
Tuberculosis
drug-resistant mycobacterium tuberculosis
household contacts
latent tuberculosis infection
Meta-analysis
作者简介
张大卫(1991—),女,硕士,医师,研究方向:结核病防制。
