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目的：系统评价耐多药肺结核疗效的影响因素，为耐多药肺结核的防治提供参考依据。方法：通过计算机检索、收集中文数据库（中国知网、维普、万方、Sinomed）和英文数据库（Pubmed、Web of science、Medline、Embase、Scopus）中耐多药肺结核疗效影响因素的病例对照研究，检索时限为建库至2023年1月，经筛选和质量评价后使用RevMan 5.4进行Meta分析。结果：最终纳入文献20篇，样本量为7 328例。结果显示复治、并发症、不良反应、性别与耐多药肺结核的疗效相关，各因素OR值及其95%CI分别为0.22(0.17～0.29)、0.38(0.32～0.46)、0.27(0.17～0.44)、0.43(0.33～0.56)。结论：并发症、复治、不良反应、男性是耐多药肺结核治疗有效的危险因素，在临床实践中对于不同类型的患者需要更有针对性的措施。受研究数量的限制，上述结论需要更多研究予以论证。
Abstract：Objective: To systematically review the influencing factors of the treatment outcome of multidrug-resistant pulmonary tuberculosis and provide reference for the prevention and treatment of multidrug-resistant pulmonary tuberculosis. Method: Case control studies on the factors influencing the treatment outcome of multidrug-resistant pulmonary tuberculosis in Chinese databases(CNKI, VIP, Wanfang, Sinomed) and English databases(Pubmed, Web of science, Medline, Embase, Scopus) were searched and collected by computer. The search period was from the establishment of the database to January 2023. After screening and quality evaluation, RevMan5.4 was used for meta-analysis. Result:Totally 18 articles were ultimately included, with a sample size of 7 328 people. The results showed that retreatment, complications, adverse reactions, and gender were related to the treatment outcome of multidrug-resistant pulmonary tuberculosis. The OR values and 95% CI of each factor were 0.22(0.17-0.29), 0.38(0.32-0.46), 0.27(0.17-0.44), and 0.43(0.33-0.56), respectively. Conclusion: Complications, retreatment, adverse reactions, and male gender are effective risk factors for the treatment outcome of multidrug-resistant pulmonary tuberculosis.In clinical practice, more targeted measures are needed for different types of patients. Due to the limitations of the number of studies, the above conclusions require more research to support them.
1宋敏，陆普选，方伟军，等.2022年WHO全球结核病报告：全球与中国关键数据分析[J].新发传染病电子杂志，2023,8(1):87-92.
2舒薇，刘宇红.精进臻善惟实励新：世界卫生组织《2022年全球结核病报告》解读[J].中国防痨杂志，2023,45(5):454-457.
3孙强，闫赟，边学峰，等.耐多药肺结核患者医疗费用及经济负担分析[J].中国卫生经济，2011,30(1):33-35.
4 Organization WH.Global Tuberculosis report WHO2013[J].Global Tuberculosis Report,2013,6(2）.
5包昌琳，易恒仲，唐益，等.耐多药肺结核患者化学治疗疗效及其影响因素分析[J].中国防痨志，2018,40(5):525-530.
6吕德良，谭卫国，张乐平，等.深圳市耐多药结核病治疗效果及影响因素分析[J].中国防痨杂志，2017,39(2):184-190.
7王丹吉，卢鹏，刘巧，等.耐多药肺结核患者治疗转归的影响因素分析[J].结核病与肺部健康杂志，2017,6(3):254-259.
8苗艳芳，宋承平，刘群群，等.耐多药和广泛耐药肺结核患者疗效分析[J].中国药物与临床，2016,16(10):1466-1469,1470.
9邝浩斌，谢育红，冯治宇，等.2014-2019年广州市耐多药肺结核管理策略实施效果分析[J].中国防痨杂志，2021,43(2):113-118.
10张玲.耐多药肺结核治疗及其影响因素分析[J].临床肺科杂志，2016,21(8):1508-1511.
11殷美静，宋立婷，张艳，等.西安市96例耐多药肺结核治疗转归现况及其影响因素分析[J].预防医学情报杂志，2020,36(10):1285-1290.
12郭净，刘忠达，张尊敬，等.丽水市耐多药肺结核治疗效果及影响因素分析[J].预防医学，2018,30(10):987-991.
13林志浩，丘小燕，马晓慧，等.佛山市193例耐多药肺结核患者的治疗转归及影响因素分析[J].实用预防医学，2022,29(11):1290-1294.
14 Javaid A,Ullah I,Masud H,et al.Predictors of poor treatment outcomes in multidrug-resistant tuberculosis patients:A retrospective cohort study[J].Clin Microbiol Infect,2018,24(6):612-617.
15 Kempker RR,Kipiani M,Mirtskhulava V,et al.Acquired drug resistance in mycobacterium tuberculosis and poor outcomes among patients with multidrug-resistant tuberculosis[J].Emerg Infect Dis,2015,21(6):992-1001.
16 Van LH,Phu PT,Vinh DN,et al.Risk factors for poor treatment outcomes of 2266 multidrug-resistant tuberculosis cases in Ho Chi Minh City:A retrospective study[J].BMC Infect Dis,2020,20(1):164.
17 Bastard M,Sanchez-Padilla E,Hewison C,et al.Effects of treatment interruption patterns on treatment success among patients with multidrug-resistant tuberculosis in Armenia and Abkhazia[J].J Infect Dis,2015,211(10):1607-1615.
18 Jeon DS,Shin DO,Park SK,et al.Treatment outcome and mortality among patients with multidrug-resistant tuberculosis in tuberculosis hospitals of the public sector[J].J Korean Med Sci,2011,26(1):33-41.
19 Tobóná，Rueda J,Cáceres DH,et al.Adverse treatment outcomes in multidrug resistant tuberculosis go beyond the microbe-drug interaction:Results of a multiple correspondence analysis[J].Biomedica,2020,40(4):616-625.
20 Shin SS,Pasechnikov AD,Gelmanova IY,et al.Treatment outcomes in an integrated civilian and prison MDR-TB treatment program in Russia[J].Int J Tuberc Lung Dis,2006,10(4):402-408.
21 Pradipta IS,Van't Boveneind-Vrubleuskaya N,Akkerman OW,et al.Treatment outcomes of drug-resistant tuberculosis in the Netherlands,2005-2015[J].Antimicrob Resist Infect Control,2019,12(8):115.
22 Gadallah MA,Mokhtar A,Rady M,et al.Prognostic factors of treatment among patients with multidrug-resistant tuberculosis in Egypt[J].J Formos Med Assoc,2016,115(11):997-1003.
23 Wrohan I,Nguyen TA,Nguyen VN,et al.Predictors of treatment outcomes among patients with multidrug-resistant tuberculosis in Vietnam:A retrospective cohort study[J].BMCInfect Dis,2022,22(1):68.
24 Elmi OS,Hasan H,Abdullah S,et al.Treatment outcomes of patients with multidrug-resistant tuberculosis(MDR-TB) compared with Non-MDR-TB infections in peninsular malaysia[J].Malays J Med Sci,2016,23(4):17-25.
25 Patel SV,Nimavat KB,Alpesh PB,et al.Treatment outcome among cases of multidrug-resistant tuberculosis(MDR-TB) in western India:A prospective study[J].JInfect Public Health,2016,9(4):478-484.
26 Zhang Q,Wu Z,Zhang Z,et al.Efficacy and effect of free treatment on multidrug-resistant tuberculosis[J].Exp Ther Med,2016,11(3):777-782.
27 Ahmad N,Javaid A,Basit A,et al.Management and treatment outcomes of MDR-TB:Results from a setting with high rates of drug resistance[J].Int J Tuberc Lung Dis,2015,19(9):1109-1114.
28 Kang Y,Jo EJ,Eom JS,et al.Treatment outcomes of patients with multidrug-resistant tuberculosis:Comparison of pre-and post-public-private mix periods[J].Tuberc Respir Dis (Seoul),2021,84(1):74-83.
29 Kim HR,Hwang SS,Kim HJ,et al.Impact of extensive drug resistance on treatment outcomes in non-HIV-infected patients with multidrug-resistant tuberculosis[J].Clin Infect Dis,2007,45(10):1290-1295.
30 Aibana O,Bachmaha M,Krasiuk V,et al.Risk factors for poor multidrug-resistant tuberculosis treatment outcomes in Kyiv Oblast,Ukraine[J].BMC Infect Dis,2017,17(1):129.
31 Panford V,Kumah E,Kokuro C,et al.Treatment outcomes and associated factors among patients with multidrug-resistant tuberculosis in Ashanti region,ghana:A retrospective,cross-sectional study[J].BMJOpen,2022,12(7):e062857.
32 Tang S,Tan S,Yao L,et al.Risk factors for poor treatment outcomes in patients with MDR-TB and XDR-TBin China:Retrospective multi-center investigation[J].PLo S One,2013,8(12):e82943.
33 Ma JB,Zeng LC,Ren F,et al.Treatment outcomes and risk factors of multidrug-resistant tuberculosis patients in Xi'an China:A retrospective cohort study[J].Infect Drug Resist,2022,15(29):4947-4957.
34杨佳，吕圣秀，唐光孝，等.初治与复治耐多药肺结核患者的CT表现分析[J].中国防痨杂志，2020,42(1):38-43.
35王春雷，金韬，赵鹏鹏，丁守华，周瑾，胡锦流.江苏省淮安市耐多药肺结核患者服药依从性及影响因素分析[J].中国防痨杂志，2022,44(10):1057-1062.
36 Murphy ME,Wills GH,Murthy S,et al.Gender differences in tuberculosis treatment outcomes:A post hoc analysis of the REMox TB study[J].BMC Med,2018,16(1):189.
37中国防痨协会.耐药结核病化学治疗指南（2019年简版）[J].中国防痨杂志，2019,41(10):1025-1073.
38陈静，赵鹏.贵阳市7 043例结核病患者发生抗结核药物性肝损伤的危险因素分析[J].结核与肺部疾病杂志，2021,2(4):335-339.
基本信息:
DOI：10.13210/j.cnki.jhmu.20230601.001
中图分类号:R521
引用信息:
[1]罗且宁,欧阳范献,梁翠丹,等.耐多药肺结核疗效影响因素的meta分析[J].海南医学院学报,2023,29(13):1003-1010.DOI:10.13210/j.cnki.jhmu.20230601.001.
基金信息:
海南省重大科技项目（ZDKJ2016008-02）~~
2023-06-02
2023-06-02
2023-06-02