PDF(Pubmed)
Abstract：
The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme.
This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results.
In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56-0.83, p < .01 and HR 0.93, 95% CI 0.70-1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60-0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I2 = 55.79%).
A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.
This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results.
In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56-0.83, p < .01 and HR 0.93, 95% CI 0.70-1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60-0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I2 = 55.79%).
A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.
摘要：
■世卫组织实施了直接观察治疗短期疗程（DOTS）计划，其中包括四种抗结核（TB）药物（异烟肼，吡嗪酰胺,乙胺丁醇和利福平）为期六个月，以完全根除结核病感染。根据世界卫生组织（WHO），糖尿病（DM）被认为是结核病的重要贡献者之一。2型糖尿病（DM2型）的存在使结核病治疗变得复杂。因此，本荟萃分析的目的是确定和量化2型DM对DOTS计划下治疗的TB患者治疗结局的影响.
本荟萃分析是根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行的。通过对相关文献的系统回顾,我们重点研究了接受DOTS治疗的TB和DM患者的治疗结局,包括延长治疗持续时间和复发.提取的信息包括研究设计，样本大小，患者特征和报告的治疗结果。
■在来自世界各地的44项研究中，DM对延长治疗时间和复发的影响的合并HR分别为HR0.72,95%CI0.56-0.83,p<.01和HR0.93,95%CI0.70-1.04,p=.08.DM对复合结核病治疗结果影响的汇总HR计算为0.76（95％CI0.60-0.87），p<0.01，效果大小为41.18。在纳入的研究中观察到的异质性是中等的(I2=55.79%)。
■在接受DOTS治疗的TB患者中，发现DM对复发和延长治疗时间有负面影响。2型DM是TB治疗延长和TB复发率的原因。通过实施有效的管理策略和推进研究，挑战可以缓解，由于DM和TB之间复杂的相互作用而产生。
本荟萃分析是根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行的。通过对相关文献的系统回顾,我们重点研究了接受DOTS治疗的TB和DM患者的治疗结局,包括延长治疗持续时间和复发.提取的信息包括研究设计，样本大小，患者特征和报告的治疗结果。
■在来自世界各地的44项研究中，DM对延长治疗时间和复发的影响的合并HR分别为HR0.72,95%CI0.56-0.83,p<.01和HR0.93,95%CI0.70-1.04,p=.08.DM对复合结核病治疗结果影响的汇总HR计算为0.76（95％CI0.60-0.87），p<0.01，效果大小为41.18。在纳入的研究中观察到的异质性是中等的(I2=55.79%)。
■在接受DOTS治疗的TB患者中，发现DM对复发和延长治疗时间有负面影响。2型DM是TB治疗延长和TB复发率的原因。通过实施有效的管理策略和推进研究，挑战可以缓解，由于DM和TB之间复杂的相互作用而产生。
