摘要
目的:采用Meta分析法评价耐药结核与敏感结核影像学特征,并分析两者差异性.方法:计算机检索PubMeD、Web of Science等英文数据库及中国知网、万方数据知识服务平台、维普网等中文数据库公开发表的耐药结核与敏感结核影像学差异相关文献,时间限定为建库起至 2024年 3月.关键词包括"耐药结核""敏感结核""CT""multidrug-resistant tuberculosis""computed tomography""drug-sensitive tuberculosis".实验组均为病原学或分子生物学证实的耐药结核,对照组为敏感结核.提取纳入文献的资料,包括第一作者、发表年份、耐药情况、样本量、影像学特征等;采用NOS量表评价纳入文献的质量,纳入≥6分高质量文献;主要结局指标包括病变分布情况、病变形态、纵隔淋巴结改变等.Meta分析采用 Stata MP 18软件;最后采用Begg's和Egger's检验对发表偏移进行分析.结果:最终纳入 11篇文献,共包含1 352例耐药结核患者及1 852名敏感结核患者,各文献的选择偏倚均为低风险.Meta 分析结果显示,实验组病灶累计≥3个肺叶发生率(RR=1.32,95%CI:1.26～1.39)、毁损肺发生率(RR=5.02,95%CI:3.59～7.01)、空洞发生率(RR=1.55,95%CI:1.47～1.69)、肺实变率(RR=1.35,95%CI:1.24～1.46)、肺不张发生率(RR=1.36,95%CI:1.16～1.60)均高于对照组,治疗后病灶吸收(RR=0.63,95%CI:0.57～0.71)低于对照组,纵隔淋巴结肿大发生率(RR=1.09,95%CI:0.94～1.26)、胸腔积液发生率(RR=1.01,95%CI:0.87～1.16)差异无统计学意义.漏斗图结果显示病变分布、肺实变、纵膈淋巴结肿大情况3种效应指标存在发表偏移.结论:耐药结核与敏感结核相比,病变范围更广,肺实变、肺不张、纵隔淋巴结肿大发生率更高,治疗后病变吸收更低,胸腔积液发生率无明显差异,这对耐药结核的早期诊断可提供一定的依据.
Abstract
Objective Meta-analysis was used to evaluate the imaging characteristics of drug-resistant and sensitive tuber-culosis and to analyze the differences.Methods We searched PubMed,Web of Science,and China National Knowledge Infra-structure using the following search terms:"multidrug-resistant tuberculosis""computed tomography""drug-sensitive tuber-culosis",in which the time limited was from the establishment of databases to March 2024.The experimental group comprised patients with confirmed drug-resistant tuberculosis based on pathogen or molecular biology criteria,while the control group consisted of individuals with drug-sensitive tuberculosis.Data extraction from the included literature encompassed details such as first author,publication year,drug resistance status,sample size,imaging features,etc.Quality assessment of the included studies was performed using the NOS scale.Meta-analysis was carried out using Stata MP 18 software.Begg's and Egger's tests were employed to evaluate publication bias.Results Ultimately,eleven articles were included in our analysis,comprising 1352 patients with drug-resistant tuberculosis and 1852 patients with sensitive tuberculosis.The results of meta-analysis showed that in the experimental group,the incidence of cumulative lesions≥3 lung lobes(RR=1.32,95%CI 1.26-1.39),the incidence of damaged lung(RR=5.02,95%CI 3.59-7.01),and the incidence of cavities(RR=1.55,95%CI 1.47-1.69),lung consolida-tion rate(RR=1.35,95%CI 1.24-1.46),incidence of atectasis(RR=1.36,95%CI 1.16-1.60),was higher than that of control group,and lesion absorption after treatment(RR=0.63,95%CI 0.57-0.71)was lower than that of control group,the incidence of pleural effusion(RR=1.01,95%CI 0.87-1.16)and the incidence of mediastinal lymph node enlargement(RR=1.09,95%CI 0.94-1.26)showed no significant difference between the two groups.The funnel plot results indicated publication bias in three effect indicators:lesion distribution,lung consolidation,and mediastinal lymph node enlargement.Conclusion Drug-resistant tuberculosis differs from sensitive tuberculosis in the distribution of lesions,lesion morphology,dynamic changes in the disease,and changes in the mediastinal lymph nodes,which can help in early diagnosis.
基金项目
国家临床重点专科重大科研专项项目(20230382)
张家界市科技发展重点专项项目(202304)
万方数据