肺泡灌洗液中T淋巴细胞亚群水平对于肺结核诊断和疗效判断的Meta分析

目的运用Meta分析方法系统评价肺泡灌洗液(BALF)中T淋巴细胞亚群水平对肺结核的诊断和疗效判断的意义,为肺结核的临床诊断提供一定参考。方法由两位评价者独立进行多个中英文数据库检索,同时进行筛选并提取资料,检索了2000年1月至2020年5月关于BALF中T淋巴细胞亚群水平分析诊断肺结核的临床研究,使用RevMan5.3软件进行Meta分析并绘制森林图。共检索文献526篇,最终纳入8篇,共计332例患者。结果BALF中T淋巴细胞亚群水平分析诊断肺结核的Meta分析:7篇文献联合肺结核患者和非肺结核患者比较,病例组的BALF中CD4+/CD8+T淋巴细胞低于对照组,差异具有统计学意义,异质性检验结果提示异质性较大(I2=95%,P<0.00001);采用随机效应模型合并效应量,结果显示两组数据差异仍具有统计学意义(WMD=-0.54,95%CI[-0.80,-0.29],P<0.0001)。BALF中T淋巴细胞亚群水平分析对肺结核疗效判断的Meta分析:5篇文献进行治疗前、后肺结核患者BALF中CD4^+/CD8^+T淋巴细胞的比较,经治疗该比值升高,且治疗前、后数值差异具有统计学意义,异质性检验结果提示异质性较大(I2=98%,P<0.00001),采用随机效应模型合并效应量,结果显示两组数据差异仍具有统计学意义(WMD=0.74,95%CI[0.40,1.09],P<0.0001)。结论肺结核患者BALF中CD4^+/CD8^+T淋巴细胞低于非肺结核患者,经治疗后BALF中CD4^+/CD8^+T淋巴细胞明显升高。因此,BALF中T淋巴细胞亚群水平分析对肺结核的诊断、疗效判断有重要价值。

Meta analysis of the levels of T lymphocyte subsets in bronchoalveolar lavage fluid for diagnosis and efficacy judgment of pulmonary tuberculosis

Objective To systematically evaluate the significance of levels of T lymphocyte subsets in bronchoalveolar lavage fluid(BALF)in the diagnosis and efficacy judgment of pulmonary tuberculosis,and to provide some references for the clinical diagnosis of pulmonary tuberculosis.Methods Two reviewers independently conducted multiple database searches in Chinese and English,screened and extracted data at the same time,and retrieved clinical studies on the diagnosis of pulmonary tuberculosis by analysis of the levels of T lymphocyte subsets in BALF from January 2000 to May 2020,and used RevMan 5.3 software to conduct Meta analysis and draw forest map.A total of 526 articles were retrieved,and 8 articles were finally included,with a total of 332 patients.Results Meta analysis on the levels of T lymphocyte subsets in BALF for the diagnosis of pulmonary tuberculosis:7 articles were combined with tuberculosis patients and non-tuberculous patients to compare,the CD4+/CD8+T lymphocytes in BALF of the case group was lower than that of the control group,and the difference was statistically significant,the result of heterogeneity test indicated that the heterogeneity was larger(I2=95%,P<0.00001);the random effect model combine the effect amount showed that the difference between the two groups was still statistically significant(WMD=-0.54,95%CI[-0.80,-0.29],P<0.0001).Meta analysis on the levels of T lymphocyte subsets in BALF of efficacy judgment of tuberculosis:the CD4^+/CD8^+T lymphocytes in BALF of patients with pulmonary tuberculosis before and after treatment was compared in the 5 literatures,after treatment,the ratio increased and the difference was statistically significant,the results of heterogeneity test indicated that the heterogeneity was larger(I2=98%,P<0.00001);the random effect model combine the effect amount showed that the difference in data between the two groups was still statistically significant(WMD=0.74,95%CI[0.40,1.09],P<0.0001).Conclusion The CD4^+/CD8^+T lymphocytes in the BALF of pulmonary tuberculosis patients was lower than that of non-tuberculosis patients.After treatment,the CD4^+/CD8^+T lymphocytes in the BALF increased significantly.Therefore,the analysis of the levels of T lymphocyte subsets in BALF is of great value for the diagnosis and treatment of tuberculosis.