我们定量评估了抗结核治疗(ATT)在结核性葡萄膜炎(TBU)患者中的疗效。主要结局指标包括炎症复发,减少炎症,炎症完全消退,改善视力(VA),能够将皮质类固醇逐渐减少至<10mg/天,而不会出现炎症进展,以及在ATT上使用辅助免疫抑制剂。这篇评论在PROSPERO(CRD42020206845)中注册。纳入了49项报告4,017例TBU患者数据的研究。在比较研究中,接受ATT±皮质类固醇治疗的TBU患者与未接受ATT治疗的TBU患者的炎性复发比值比(OR)为0.33(95CI:0.19~0.60).对于接受ATT±皮质类固醇治疗的TBU患者,合并的炎症复发的绝对发生率,炎症减少,炎症完全消退,视力改善为13%(n=310/2,216;95CI:9-18),81%(n=217/276;95CI:62-95),83%(n=1,167/1,812;95CI:77-89),和65%(n=347/542;95CI:51-78),分别。91%(n=326/395;95CI:78-99)的患者中,皮质类固醇逐渐减少至<10mg/天,无炎症进展,9%(n=121/1,376;95CI:6-13)的患者与ATT同时服用免疫抑制剂。我们得出的结论是,用ATT±皮质类固醇治疗TBU与高水平的炎症控制或改善有关。更多前瞻性研究,详细报告ATT方案,患者亚组,和结果需要更好地评估ATT的有效性。
We quantitatively evaluated the efficacy of antitubercular therapy (ATT) in tubercular uveitis (TBU) patients. Main outcome measures include inflammation recurrence, inflammation reduction, complete resolution of inflammation, improved visual acuity (VA), ability to taper corticosteroids to < 10 mg/day without inflammatory progression, and use of adjunctive immunosuppressants while on ATT. This
review is prospectively registered in PROSPERO (CRD42020206845). Forty-nine studies reporting data for 4,017 TBU patients were included. In comparative studies, the odds ratio (OR) of inflammatory recurrence was 0.33 (95%CI:0.19-0.60) for TBU patients treated with ATT±corticosteroid versus no ATT. For TBU patients treated with ATT±corticosteroid, the pooled absolute incidences of inflammatory recurrence, inflammatory reduction, complete resolution of inflammation, and visual acuity improvement were 13% (n=310/2,216; 95%CI:9-18), 81% (n=217/276; 95%CI: 62-95), 83% (n=1,167/1,812; 95%CI: 77-89), and 65% (n=347/542; 95%CI:51-78), respectively. Corticosteroids were tapered to <10 mg/day without inflammatory progression in 91% (n=326/395; 95%CI:78-99) of patients, 9% (n=121/1,376; 95%CI:6-13) of whom were administered concomitant immunosuppressive agents alongside ATT. We conclude that treatment of TBU with ATT±corticosteroid is associated with a high level of control or improvement of inflammation. More prospective studies with detailed reporting of ATT regimens, patient subgroups, and outcomes are required to better evaluate ATT effectiveness.