PDF(Pubmed)
Abstract：
BACKGROUND: The rate of pulmonary tuberculosis (TB) recurrence is substantial. Identifying risk factors can support the development of prevention strategies.
METHODS: We retrieved studies published between 1 January 1980 and 31 December 2022 that assessed factors associated with undifferentiated TB recurrence, relapse or reinfection. For factors reported in at least four studies, we performed random-effects meta-analysis to estimate a pooled relative risk (RR). We assessed heterogeneity, risk of publication bias and certainty of evidence.
RESULTS: We included 85 studies in the review; 81 documented risk factors for undifferentiated recurrence, 17 for relapse and 10 for reinfection. The scope for meta-analyses was limited given the wide variety of factors studied, inconsistency in control for confounding and the fact that only few studies employed molecular genotyping. Factors that significantly contributed to moderately or strongly increased pooled risk and scored at least moderate certainty of evidence were: for undifferentiated recurrence, multidrug resistance (MDR) (RR 3.49; 95% CI 1.86 to 6.53) and fixed-dose combination TB drugs (RR 2.29; 95% CI 1.10 to 4.75) in the previous episode; for relapse, none; and for reinfection, HIV infection (RR 4.65; 95% CI 1.71 to 12.65). Low adherence to treatment increased the pooled risk of recurrence 3.3-fold (95% CI 2.37 to 4.62), but the certainty of evidence was weak.
CONCLUSIONS: This review emphasises the need for standardising methods for TB recurrence research. Actively pursuing MDR prevention, facilitating retention in treatment and providing integrated care for patients with HIV could curb recurrence rates. The use of fixed-dose combinations of TB drugs under field conditions merits further attention.
UNASSIGNED: CRD42018077867.
METHODS: We retrieved studies published between 1 January 1980 and 31 December 2022 that assessed factors associated with undifferentiated TB recurrence, relapse or reinfection. For factors reported in at least four studies, we performed random-effects meta-analysis to estimate a pooled relative risk (RR). We assessed heterogeneity, risk of publication bias and certainty of evidence.
RESULTS: We included 85 studies in the review; 81 documented risk factors for undifferentiated recurrence, 17 for relapse and 10 for reinfection. The scope for meta-analyses was limited given the wide variety of factors studied, inconsistency in control for confounding and the fact that only few studies employed molecular genotyping. Factors that significantly contributed to moderately or strongly increased pooled risk and scored at least moderate certainty of evidence were: for undifferentiated recurrence, multidrug resistance (MDR) (RR 3.49; 95% CI 1.86 to 6.53) and fixed-dose combination TB drugs (RR 2.29; 95% CI 1.10 to 4.75) in the previous episode; for relapse, none; and for reinfection, HIV infection (RR 4.65; 95% CI 1.71 to 12.65). Low adherence to treatment increased the pooled risk of recurrence 3.3-fold (95% CI 2.37 to 4.62), but the certainty of evidence was weak.
CONCLUSIONS: This review emphasises the need for standardising methods for TB recurrence research. Actively pursuing MDR prevention, facilitating retention in treatment and providing integrated care for patients with HIV could curb recurrence rates. The use of fixed-dose combinations of TB drugs under field conditions merits further attention.
UNASSIGNED: CRD42018077867.
摘要：
背景：肺结核（TB）的复发率很高。识别风险因素可以支持预防战略的制定。
方法：我们检索了1980年1月1日至2022年12月31日发表的评估与未分化结核病复发相关因素的研究，复发或再感染。对于至少四项研究中报告的因素，我们进行了随机效应荟萃分析以估计合并相对风险(RR).我们评估了异质性，发表偏倚的风险和证据的确定性。
结果：我们纳入了85项研究；81项记录了未分化复发的危险因素，17用于复发，10用于再感染。鉴于研究的因素多种多样，荟萃分析的范围有限，对混杂因素的控制不一致，以及只有少数研究采用分子基因分型的事实。显著导致合并风险中度或重度增加且证据确定性得分至少中等的因素是：对于未分化复发，多药耐药(MDR)(RR3.49;95%CI1.86至6.53)和固定剂量联合结核病药物(RR2.29;95%CI1.10至4.75)；对于复发，没有；对于再感染，HIV感染（RR4.65；95%CI1.71至12.65）。对治疗的低依从性使合并的复发风险增加了3.3倍（95％CI2.37至4.62），但是证据的确定性很弱。
结论：这篇综述强调了结核病复发研究方法标准化的必要性。积极推行耐多药预防，促进保留治疗和为HIV患者提供综合护理可以抑制复发率.在野外条件下使用固定剂量的结核病药物组合值得进一步关注。
■CRD42018077867。
方法：我们检索了1980年1月1日至2022年12月31日发表的评估与未分化结核病复发相关因素的研究，复发或再感染。对于至少四项研究中报告的因素，我们进行了随机效应荟萃分析以估计合并相对风险(RR).我们评估了异质性，发表偏倚的风险和证据的确定性。
结果：我们纳入了85项研究；81项记录了未分化复发的危险因素，17用于复发，10用于再感染。鉴于研究的因素多种多样，荟萃分析的范围有限，对混杂因素的控制不一致，以及只有少数研究采用分子基因分型的事实。显著导致合并风险中度或重度增加且证据确定性得分至少中等的因素是：对于未分化复发，多药耐药(MDR)(RR3.49;95%CI1.86至6.53)和固定剂量联合结核病药物(RR2.29;95%CI1.10至4.75)；对于复发，没有；对于再感染，HIV感染（RR4.65；95%CI1.71至12.65）。对治疗的低依从性使合并的复发风险增加了3.3倍（95％CI2.37至4.62），但是证据的确定性很弱。
结论：这篇综述强调了结核病复发研究方法标准化的必要性。积极推行耐多药预防，促进保留治疗和为HIV患者提供综合护理可以抑制复发率.在野外条件下使用固定剂量的结核病药物组合值得进一步关注。
■CRD42018077867。
