糖皮质激素联合抗结核药物治疗对结核性浆膜炎有效性、不良反应及病死率的Meta分析  

Meta-analysis of the efficacy,adverse reactions,and fatality rate of glucocorticoid combined with anti-tuberculosis drugs in the treatment of tuberculous serositis

作　　者：石宜林 顾岩[1] Shi Yilin;Gu Yan(District A,Department of Respiratory and Critical Care Medicine,Inner Mongolia Medical University Affiliated Hospital,Hohhot 010030,China;Department of Emergency,Inner Mongolia Fourth Hospital,Hohhot 010000,China)

机构地区：[1]内蒙古医科大学附属医院呼吸与危重症医学科A区,呼和浩特010030 [2]内蒙古自治区第四医院急诊科,呼和浩特010000

出　　处：《中国防痨杂志》2025年第1期77-86,共10页Chinese Journal of Antituberculosis

基　　金：内蒙古医科大学附属医院培育项目(2023NYFYPY005);自然科学基金联合项目(2023LHMS08062);自然科学重点项目(NJZZ20131);内蒙古自治区科技计划项目(2022YFSH0002);内蒙古医科大学科技创新团队胸膜疾病诊疗创新团队(YKD2022TD013);内蒙古医科大学联合项目(YKD2021LH012);内蒙古自治区科技攻关项目(2019GG045);内蒙古自治区医师协会临床医学研究和临床新技术推广项目(YSXH2024KYF028)。

摘　　要：目的:系统评价糖皮质激素联合抗结核药物治疗结核性浆膜炎有效率、不良反应及病死率的变化。方法:采用主题词与自由词相结合的方式,从中国知网、万方、维普、中国生物医学文献数据库、PubMed和Web of Science中检索糖皮质激素联合抗结核药物治疗结核性浆膜炎的随机对照实验(RCT)并纳入研究文章中的参考文献,检索时限均从建库至2024年8月1日。中文检索词包括肺外结核、结核性脑膜炎、结核性胸膜炎、结核性心包炎、糖皮质激素、类固醇激素、地塞米松、甲泼尼龙等;英文检索词包括extrapulmonary tuberculosis,tuberculous meningitis,tuberculous pleurisy,tuberculous pericarditis,glucocorticoids,steroid hormones,dexamethasone,methylprednisolone等。由2名研究人员独立筛选文献、提取数据、评价文献质量后,采用Stata 15.1软件对纳入的数据进行异质性检验分析及发表偏倚分析,以对结核性浆膜炎在抗结核治疗的基础上应用糖皮质激素后的有效性、不良反应及病死率等进行综合评价。结果:共检索到相关文献4619篇,排除不符合入组标准的文献后最终纳入31篇文献、2410例患者进行Meta分析,其中,抗结核治疗联合糖皮质激素治疗组患者(观察组)1228例,仅抗结核治疗组患者(对照组)1182例;根据疾病类型将患者再分为结核性脑膜炎组(包括23项研究,观察组876例,对照组876例)、结核性胸膜炎组(包括6项研究,观察组280例,对照组276例)和结核性心包炎组(包括2项研究,观察组72例,对照组30例)。Meta分析结果显示,与对照组相比,联合糖皮质激素对结核性脑膜炎、结核性胸膜炎和结核性心包炎的治疗有效性均更好[OR(95%CI)=4.63(3.48~6.17)、6.62(3.55~12.34)、7.92(2.44~25.66)]、对结核性脑膜炎的病死率更低[OR(95%CI)=0.45(0.23~0.87)],对结核性胸膜炎的不良反应更少[OR(95%CI)=0.31(0.18~0.52)]。结论:糖皮质激素联合抗结核药物治疗可提�Objective:To systematically evaluate the efficacy,adverse reactions and mortality of glucocorticoids combined with anti-tuberculosis drugs in the treatment of tuberculous serositis.Methods:Randomized controlled trials(RCTs)of glucocorticoids combined with anti-tuberculosis drugs in the treatment of tuberculous serositis were retrieved from CNKI,Wanfang,VIP,China Biomedical Literature Database,PubMed and Web of Scienceby using a combination of subject words and free words,and references in research articles were included.The search period was from the establishment of the database to August 1,2024.Chinese search terms include extra pulmonary tuberculosis,tuberculous meningitis,tuberculous pleurisy,tuberculous pericarditis,glucocorticoids,steroid hormones,dexamethasone,methylprednisolone,etc.;English search terms include tuberculosis,tuberculous meningitis,tuberculous pleurisy,tuberculous pericarditis,glucocorticoids,steroid hormones,dexamethasone,methylprednisolone,etc.Two researchers independently screened the literature,extracted the data,and evaluated the quality of the literature,and then used Stata 15.1 software to analyze the heterogeneity of the included data and analyze the publication bias to comprehensively evaluate the efficacy,adverse reactions and mortality of tuberculous serositis after glucocorticoids on the basis of anti-tuberculosis therapy.Results:A total of 4619 related literatures were retrieved.After excluding the literatures that did not meet the inclusion criteria,31 literatures and 2410 patients were included for meta-analysis.Among them,1228 patients in the anti-tuberculosis therapy combined with glucocorticoids therapy group(experimental group)and 1182 patients in the anti-tuberculosis treatment group(control group).According to the type of disease,the patients were further divided into tuberculous meningitis group(including 23 studies,876 cases in the experimental group and 876 cases in the control group),tuberculous pleurisy group(including 6 studies,280 cases in the experimental group

关 键 词：结核 浆膜炎 抗结核药 糖皮质激素类 治疗结果 Meta分析(主题) 

分 类 号：R52[医药卫生—内科学] R561.1[医药卫生—临床医学] R572.2R542.11R45R181.2