肺结核患者并发肺部真菌感染危险因素的meta分析

目的 系统评价肺结核患者并发肺部真菌感染的主要危险因素。 方法 在线检索中国知网、维普、万方和PubMed数据库中从建库至2020年2月28日发表的与肺结核患者并发肺部真菌感染相关文献,两名研究者根据纳入排除标准独立筛选文献、提取数据和质量评价后,采用Stata 12.0软件进行统计分析。 结果 最终纳入文献16篇,meta分析结果显示:年龄≥60岁(OR=4.51,95%CI:1.85~10.96)、病程≥5年(OR=4.32,95%CI:3.04~6.14)、复治肺结核(OR=5.82,95%CI:3.08~11.00)、病变累及肺野数≥3个(OR=2.82,95%CI:2.33~3.42)、有肺部空洞(OR=3.44,95%CI:2.06~5.75)、合并糖尿病(OR=2.05,95%CI:1.75~2.42)、侵入性操作(OR=6.42,95%CI:4.54~9.08)、长期使用广谱抗生素(OR=4.52,95%CI:1.79~11.39)、长期使用糖皮质激素(OR=3.74,95%CI:2.26~6.19)、痰涂片阳性(OR=0.49,95%CI:0.28~0.87)与肺结核患者并发肺部真菌感染相关;性别与肺结核患者并发肺部真菌感染未见明显关联(P=0.066)。 结论 高龄、病程长、复治肺结核、病变累及肺野数多、有肺部空洞、合并糖尿病、侵入性操作、长期使用广谱抗生素、长期使用糖皮质激素是肺结核患者并发肺部真菌感染的主要危险因素。

Risk factors of pulmonary fungal infection in patients with pulmonary tuberculosis: a meta-analysis

Objective To systematically review the main risk factors of pulmonary fungal infection in patients with pulmonary tuberculosis. Methods Literatures about pulmonary fungal infection in patients with pulmonary tuberculosis were retrieved from CNKI, VIP, Wanfang and PubMed from their establishment to February 28, 2020. Two researchers independently screened theliteratures according to the inclusion and exclusion criteria, extracted the data and evaluated the quality. The meta-analysis was performed by Stata12.0. Results A total of 16 studies were included in the final analysis. The meta-analysis showed that patients aged 60 years and above (OR=4.51, 95%CI:1.85-10.96), duration of disease more than or equal to 5 years (OR=4.32, 95%CI:3.04-6.14), retreated pulmonary tuberculosis (OR=5.82, 95%CI: 3.08-11.00), number of lesion more than or equal to 3 pulmonary fields (OR=2.82, 95%CI: 2.33-3.42), having pulmonary cavity (OR=3.44, 95%CI: 2.06-5.75), complicated with diabetes (OR=2.05, 95%CI: 1.75-2.42), invasive procedures (OR=6.42, 95%CI: 4.54-9.08), long-term use of broad-spectrum antibiotics (OR=4.52, 95%CI:1.79-11.39), long-term use of glucocorticoids (OR=3.74, 95%CI:2.26-6.19) and sputum smear positive (OR=0.49, 95%CI: 0.28-0.87) were associated with the development of pulmonary fungal infection in patients with pulmonary tuberculosis, but there was no significant association between gender and the development of pulmonary fungal infection in patients with pulmonary tuberculosis (P=0.066). Conclusion The main risk factors of pulmonary fungal infection in patients with pulmonary tuberculosis are advanced age, long-term course of disease, retreated pulmonary tuberculosis, wide range of pulmonary lesion, having pulmonary cavity, complicated with diabetes, invasive procedures, long-term use of broad-spectrum antibiotics and long-term use of glucocorticoids.