3种不同介入方法治疗气管支气管结核的网状Meta分析  

Network Meta-Analysis of Three Different Interventional Methods for the Treatment of Tracheobronchial Tuberculosis

作　　者：姚晓蝶 樊浩 沈凌筠 郑胜安 蒋孟函 沈磊 陈洁 刘幸 YAO Xiaodie;FAN Hao;SHEN Lingjun;ZHENG Shengan;JIANG Menghan;SHEN Lei;CHEN Jie;LIU Xing(School of Pharmaceutical Sciences,Dali University,Dali Yunnan 671000;The Third People’s Hospital of Kunming/Yunnan Provincial Infectious Disease Clinical Medical Center,Kunming Yunnan 650041,China)

机构地区：[1]大理大学药学院,云南大理671000 [2]昆明市第三人民医院/云南省传染性疾病临床医学中心,云南昆明650041

出　　处：《昆明医科大学学报》2023年第9期110-120,共11页Journal of Kunming Medical University

基　　金：昆明市卫生健康委员会卫生科研基金资助项目(20220308004)。

摘　　要：目的系统评价不同支气管镜下介入方法联合常规抗结核方案治疗气管支气管结核(TBTB)的疗效与安全性,为临床提供循证参考。方法计算机检索PubMed、Web of Science、EMBase、中国知网(CNKI)、万方数据库(Wanfang)、维普数据库(VIP),收集不同支气管镜下介入方法(局部给药、冷冻治疗和雾化治疗)联合常规抗结核治疗的随机对照试验(RCT),提取数据资料并进行质量评价后,利用软件Stata 16.0进行网状Meta分析。结果共纳入38项RCT,共计3114名患者,涉及常规+局药、常规+冷冻、常规+局药+雾化等3种干预措施。与常规治疗比较,常规+冷冻、常规+局药、常规+局药+雾化均可显著缓解临床症状,提高有效率(P<0.05),网状Meta排序结果为:常规+局药+雾化>常规+局药>常规+冷冻>常规;纤维支气管镜下,与常规治疗比较,常规+冷冻、常规+局药、常规+局药+雾化均可显著提高治疗有效率(P<0.05),网状Meta排序结果为:常规+局药>常规+局药+雾化>常规+冷冻>常规;与常规治疗比较,常规+局药、常规+局药+雾化均可显著提高患者治疗后8周末痰菌转阴率(P<0.05);与常规+冷冻相比,常规+局药可显著提高患者治疗后8周末痰菌转阴率(P<0.05)。网状Meta排序结果为:常规+局药>常规+局药+雾化>常规+冷冻>常规;与常规治疗比较,常规+局药可显著提高患者治疗后24周末痰菌转阴率(P<0.05),网状Meta排序结果为常规+局药>常规+局药+雾化>常规+冷冻>常规;在不良反应发生率方面,各组组间比较,差异均无统计学意义(P>0.05)。结论常规+局药+雾化方案提高疗效最为显著,而常规+局药方案在纤维支气管镜下治疗有效率方面效果最佳;TBTB患者早期应用常规+局药+雾化方案可加速痰菌转阴,但在长期治疗中应用常规+局药方案痰菌转阴效果更佳;在常规抗结核基础上联用支气管镜下介入治疗不会增加不良反应,安全性良好。但研究有待纳入更多�Objective To systematically evaluate the efficacy and safety of different bronchoscopic intervention methods combined with the conventional anti-tuberculosis regimen in the treatment of tracheobronchial tuberculosis(TBTB),and to provide the evidence-based reference for clinical practice.Methods Computer search PubMed,Web of Science,EMBase,CNKI,Wanfang Database,VIP database,randomized controlled trials(RCTS)of different bronchoscopic interventions(local administration,cryotherapy,and atomization)combined with conventional anti-tuberculosis therapy were collected.After the data extraction and quality evaluation,network meta-analysis was performed using Stata 16.0 software.Results A total of 38 RCTS were included,involving a total of 3114 patients and three interventions(conventional+local administration,conventional+cryotherapy,conventional+local administration+atomization).Compared with the conventional treatment,conventional+cryotherapy,conventional+local administration,conventional+local administration+atomization could significantly improve the total clinical response rate(P<0.05).The results of mesh Meta ranking were conventional+local administration+atomization>conventional+local administration>conventional+cryotherapy>conventional.Compared with the conventional treatment,conventional+cryotherapy,conventional+local administration,conventional+local administration+atomization could significantly improve the effective rate of fiberoptic bronchoscopy(P<0.05).The results of mesh Meta ranking were conventional+local administration>conventional+local administration+atomization>conventional+cryotherapy>conventional.Compared with the conventional treatment,conventional+local administration,conventional+local administration+atomization could significantly improve the sputum negative conversion rate at the end of 8 weeks after the treatment(P<0.05).Compared with conventional+cryotherapy,conventional+local administration could significantly improve the sputum negative conversion rate at the end of 8 weeks after treatmen

关 键 词：网状Meta分析 支气管镜下介入治疗 气管支气管结核 疗效 系统评价 

分 类 号：R-1[医药卫生]