中国结核病控制直接面视下督导化疗的系统评价

目的 评价直接面视下督导化疗（DOT）对结核病病例管理的效果.方法 通过《中国全文期刊网》（CNKI）、万方数据库和Medline数据库检索1994-2004年关于DOT有关文献和资料,并进行系统评价,包括定量分析（Meta分析）和定性分析;评价指标为治愈率.结果 共检索204篇文献,入选120篇.（1）管理措施：全程督导组与全程管理组治愈率合并后率差RD值（95%CI）为0.14（0.06～0.22）,P＜0.000 01.按全程管理执行严格程度进行分层分析,全程督导和管理严格的全程管理组差异无统计学意义（P=0.06）,RD值（95%CI）为0.02（0.00～0.03）,全程督导与未提及是否严格的全程管理组差异有统计学意义（P=0.004）,RD值（95%CI）为0.18（0.06～0.30）,不严格组差异有统计学意义（P＜0.05）,RD值（95%CI）为0.16（0.07～0.24）.全程督导组与自服药组差异有统计学意义（P=0.002）,RD值（95%CI）为0.24（0 10～0.38）.（2）化疗方案：短疗程与长疗程化疗方案治愈率差异有统计学意义（P=0.003）,合并RD值（95%CI）为0.04（0.01～0.07）.结论 只要管理严格,强化对结核病病例的不同管理模式,如全程督导和全程管理,可以使患者达到相同的治疗依从性.患者的依从性与化疗方案、给药方式（每日给药或间歇给药）等因素有关.

Systematic review of directly observed treatment of tuberculosis control in China

Objective To evaluate the effectiveness of directly observed treatment(DOT) implementation in tuberculosis(TB) control in China. Methods Systematic literature review was carried out for published and unpublished articles regarding DOT, and meta analysis was used to compile results from selected papers. Also, sensitive analysis was carried out to explore the potential factors influencing the effectiveness of DOT. Results Two hundred and four articles were identified from China National Knowledge Infrastructure,Wanfang and Medline databases during 1994-2004 in which 120 articles were eligible according to our selection criteria. (1)Regarding TB case management: TB patients managed under DOT was compared to cases managed under the whole course treatment management(WCM). The combined RD of cure rate was 0.14(95%CI: 0.06- 0.22) and the two case management methods were significantly different( P< 0.000 01). Data from stratified analysis showed that strict implementation of WMC had similar effectiveness with DOT( P= 0.06),and with RD 0.02( 95%CI: 0.00-0.03). However, the cure rate of DOT management was significantly better than that under un-strict WCM management( P< 0.05) with RD 0.16(95%CI: 0.07- 0.24). The cure rate of DOT was significantly better than those patients under self-administration(RD was 0.24 with 95%CI: 0.10- 0.38 and P= 0.002). (2)Chemotherapeutics: when short-course and long course-treatments were compared, the combined RD became 0.04(95%CI: 0.01- 0.07) and P= 0.003. Conclusions If the implementation was under strict management, the different models of patient management showed similar adherence rates. However, the effect of adherence would depend on the regimen, pattern of intake of the drugs and the methods of supervision being used.