儿童结核性脑膜炎死亡危险因素的Meta分析  

The risk factors for mortality in children with tuberculous meningitis:a meta-analysis

作　　者：杨文璐 万彬 赵霞 谢鹏[1] 姚蓉 吕梦玉 吴春陶 雷丽梅 YANG Wenlu;WAN Bin;ZHAO Xia;XIE Peng;YAO Rong;LV Mengyu;WU Chuntao;LEI Limei(Chengdu University of Traditional Chinese medicine,Chengdu 610036,P.R.China;Chengdu Public Health Clinical Medical Center,Chengdu 610011,P.R.China)

机构地区：[1]成都中医药大学,成都610036 [2]成都市公共卫生临床医疗中心,成都610011

出　　处：《中国循证医学杂志》2023年第8期894-900,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价儿童结核性脑膜炎(TBM)死亡的危险因素。方法计算机检索CNKI、VIP、WanFang Data、CBM、Cochrane Library、Web of Science、PubMed、EMbase和CINAHL数据库,搜集有关儿童TBM死亡危险因素的研究,检索时限均从建库至2022年10月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入15个研究,包括2597例患儿。Meta分析结果显示:男性[OR=2.41,95%CI(1.61,3.61),P<0.01]、无卡介苗接种史[OR=3.74,95%CI(1.96,7.12),P<0.01]、临床分期(Ⅲ期)[OR=2.04,95%CI(1.26,3.28),P<0.01]、合并HIV感染[OR=3.28,95%CI(1.20,8.93),P=0.02],抽搐[OR=3.61,95%CI(3.31,3.94),P<0.01]、意识障碍[OR=3.58,95%CI(2.40,5.34),P<0.01]、脑脊液蛋白浓度升高[OR=1.87,95%CI(1.39,2.51),P<0.01]、脑积水[OR=2.44,95%CI(1.60,3.71),P<0.01]、住院时间短[OR=2.89,95%CI(2.05,4.06),P<0.01]可能是儿童TBM的死亡危险因素。而年龄<5岁、PPD皮试阴性、脑膜刺激征阳性、营养不良、结核病接触史可能与儿童TBM的死亡不相关。结论男性、无卡介苗接种史、临床分期(Ⅲ期)、合并HIV感染、抽搐、意识障碍、脑脊液蛋白浓度升高、脑积水、住院时间短可能是儿童TBM死亡的危险因素。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。Objective To systematically review the risk factors for death in children with tuberculous meningitis(TBM).Methods The CNKI,VIP,WanFang Data,CBM,Cochrane Library,Web of Science,PubMed,EMbase and CINAHL databases were electronically searched to collect studies on the risk factors for death in children with TBM from inception to October 2022.Two reviewers independently screened the literature,extracted data and assessed the risk of bias of the included studies.Meta-analysis was then performed by using RevMan 5.3 software.Results A total of 15 studies involving 2597 patients were included.The results of meta-analysis showed that male(OR=2.41,95%CI 1.61 to 3.61,P<0.01),no history of BCG vaccination(OR=3.74,95%CI 1.96 to 7.12,P<0.01),TBM stage(stageⅢ)(OR=2.04,95%CI 1.26 to 3.28,P<0.01),HIV infection(OR=3.28,95%CI 1.20 to 8.93,P=0.02),convulsion(OR=3.61,95%CI 3.31 to 3.94,P<0.01),disturbance of consciousness(OR=3.58,95%CI 2.40 to 5.34,P<0.01),cerebrospinal fluid protein concentration increased(OR=1.87,95%CI 1.39 to 2.51,P<0.01),hydrocephalus(OR=2.44,95%CI 1.60 to 3.71,P<0.01)and short hospitalization(OR=2.89,95%CI 2.05 to 4.06,P<0.01)were risk factors for death in children with TBM.Under 5 years old,negative PPD skin test,positive meningeal irritation sign,malnutrition and history of contact with TB may not be associated with the death of TBM in children.Conclusion Male,no history of BCG vaccination,TBM stage(stageⅢ),HIV infection,convulsions,disturbance of consciousness,cerebrospinal fluid protein concentration increased,hydrocephalus and short hospitalization are risk factors for death in children with TBM.Due to the limited quality and quantity of the included studies,more high quality studies are needed to verify the above conclusion.

关 键 词：儿童 结核性脑膜炎 死亡 危险因素 META分析 

分 类 号：R529.3[医药卫生—内科学]