鸟分枝杆菌复合群肺病死亡率的Meta分析

李远春 张越 赵雁林 李燕明

李远春, 张越, 赵雁林, 李燕明. 鸟分枝杆菌复合群肺病死亡率的Meta分析[J]. 疾病监测, 2021, 36(1): 82-91. doi: 10.3784/jbjc.202008240291
引用本文: 李远春, 张越, 赵雁林, 李燕明. 鸟分枝杆菌复合群肺病死亡率的Meta分析[J]. 疾病监测, 2021, 36(1): 82-91. doi: 10.3784/jbjc.202008240291
Li Yuanchun, Zhang Yue, Zhao Yanlin, Li Yanming. Meta-analysis on mortality of pulmonary disease caused by Mycobacterium avium complex[J]. Disease Surveillance, 2021, 36(1): 82-91. doi: 10.3784/jbjc.202008240291
Citation: Li Yuanchun, Zhang Yue, Zhao Yanlin, Li Yanming. Meta-analysis on mortality of pulmonary disease caused by Mycobacterium avium complex[J]. Disease Surveillance, 2021, 36(1): 82-91. doi: 10.3784/jbjc.202008240291

鸟分枝杆菌复合群肺病死亡率的Meta分析

doi: 10.3784/jbjc.202008240291
基金项目: 国家自然科学基金(No. 81870013)
详细信息
    作者简介:

    李远春,女,四川省内江市人,硕士研究生在读,主要从事结核和非结核分枝杆菌肺部感染研究,Email:chunyll@163.com

    通讯作者:

    赵雁林,Tel:010–58900777,Email:zhaoyl@chinacdc.cn

    李燕明,Tel:010–85131242,Email:lymyl@263.net

  • 中图分类号: R211;R516;R563;R378.91

Meta-analysis on mortality of pulmonary disease caused by Mycobacterium avium complex

Funds: This study was supported by the National Natural Science Foundation of China (No. 81870013)
More Information
  • 摘要:   目的  探究鸟分枝杆菌复合群肺病的死亡率及影响因素。  方法  检索Medline、Cochrane、Embase、Web of Science四个数据库,收集1941年1月1日至2020年1月1日有关鸟分枝杆菌复合群(MAC)肺病的全因死亡率的研究,按照纳入和排除标准筛选文献,应用Newcastle-Ottawa scale(NOS)和Cochrane risk of bias tool评价纳入研究的质量,提取文献数据并运用 RevMan5.3和Stata 14.0软件进行 Meta 分析。  结果  共纳入48项研究6 933例患者,其中45项为队列研究,3项为随机临床试验。 31项研究报道了MAC肺病的专病病死率,14项研究报道了5年全因死亡率。MAC肺病的全因死亡率为20.00%(I2=95.00%),5年全因死亡率为26.00%(I2=94.00%),专病病死率为5.00%(I2=87.00%)。 影响MAC肺病全因死亡率的预后的因素有年龄(≥65岁)、男性、影像学空洞型、体质指数≤18.50 kg/m2和血清白蛋白<3.50 g/dL。 亚组分析显示,伴有人类免疫缺陷病毒(HIV)患者、影像学空洞型以及其他共病的MAC肺病患者全因死亡率较高。  结论  MAC肺病的全因死亡率较高,预后较差。 伴HIV患者、影像学空洞型以及合并其他疾病的患者的死亡风险增加。
  • 图  1  文献筛选流程

    Figure  1.  Flow chart of the literature reviewing and screening

    2  鸟分支杆菌复合群肺病的全因死亡率(A)、专病病死率(B)、5年全因死亡率(C)的森林图

    2.  Forest plot of all-cause mortality (A), causative mortality (B) and five-year all-cause mortality (C) of MAC pulmonary disease

    图  3  伴/不伴HIV的鸟分支杆菌复合群肺病患者的全因死亡率森林图

    Figure  3.  Forest plot of all-cause mortality of MAC pulmonary disease with/without HIV

    图  4  鸟分枝杆菌复合群肺病全因死亡率的漏斗图

    Figure  4.  Funnel plots of MAC pulmonary disease all-cause mortality rate

    表  1  纳入研究的文献的基本特征及其质量评分

    Table  1.   Characteristics and quality of included studies

     纳入研究国家研究类型研究对象
    (MAC肺病)
    平均随访时间
    (月)
    MAC肺病
    占比(%)
    研究总人数男性占比
    (%)
    平均年龄
    (岁)
    BMI
    (kg/m2)
    空洞比例
    (%)
    影像学特征
    (非空洞型/
    空洞型)
    主要治疗方法质量
    评估
    Yeager1973[4美国队列研究所有患者59.00100.0045100.00 //82.20/药物7
    Corpe1981[5美国队列研究术后患者/100.00131 80.20//94.70/手术6
    Davidson1981[6美国队列研究所有患者55.00100.00122 72.0055.10/92.60/药物8
    Kim1981[7美国队列研究所有患者84.00 73.909271.7061.00///药物6
    Rosenzweig1981[8美国队列研究所有患者60.00100.00100 ///100.00 //9
    Moran 1983[9美国队列研究所有患者94.00100.003786.0047.00/100.00 /手术6
    Prince 1989[10美国队列研究 非HIV患者/100.002119.0066.00/23.8016∶5药物+手术6
    O´Brien 1990[11美国RCT所有患者25.00100.00406 59.0058.90/21.60/药物中等
    Pomerantz1991[12美国队列研究所有患者48.00 86.803868.4050.00///手术8
    Chaisson1992[13美国队列研究HIV患者24.00100.00123 99.20/////8
    Dautzenberg1995[14法国RCT 非HIV患者10.00100.004544.0061.70///药物中上
    Nelson1998[15美国队列研究 非HIV患者39.00100.002875.0050.30/100.00 /手术7
    Shiraishi1998[16日本队列研究所有患者/100.003351.5050.00/64.006∶16∶3手术5
    BTS2002[17英国队列研究 非HIV患者60.00100.007553.3064.00/61.00/药物5
    Shiraishi2002[18日本队列研究 非HIV患者34.80100.002152.4056.00/76.001∶4手术5
    Field2003[19 加拿大队列研究 非HIV患者28.00100.003010.0070.00///药物6
    Kobashi2003[20日本队列研究所有患者16.80100.007138.0064.4054.901∶1药物8
    Maekura2005[21日本队列研究 非HIV患者160.00 100.006845.6067.00////6
    Phillips2005[22英国队列研究HIV患者29.00100.0015////9∶6药物6
    Griffith2006[23美国队列研究 非HIV患者25.70100.005145.0061.1053.0024∶27药物6
    Milanés-Virelles2008[24古巴RCT所有患者12.00 94.003275.0060.00///药物中等
    Mitchell2008[25美国队列研究所有患者/ 80.00236 17.0054.80/36.0055∶38∶7手术7
    Sim2010[26韩国队列研究所有患者12.00100.009641.7059.0019.9026.0065∶25∶10药物6
    Van Ingen2010[27荷兰队列研究 非HIV患者19.00100.00 771.40//100.00 /手术6
    Hayashi2012[28日本队列研究 非HIV患者60.00100.00634 41.0068.9019.0016.6076∶21∶3药物8
    Ito2012[29日本队列研究 所有患者60.00100.007839.7066.00/25.6046∶20∶12治/不治6
    Kobashi2013[30日本队列研究 有/无气胸患者/100.00220 44.5068.80////7
    Kyaw2013[31美国队列研究 有/无HIV患者/100.002060.0072.00/50.0010∶10药物5
    Kadota2016[32日本队列研究 非HIV患者12.00100.0033 6.1067.00/75.801∶3药物6
    Morimoto2014[33日本队列研究 所有患者60.00100.00309 35.3067.0019.10///5
    Zoumot2014[34英国队列研究 非CF患者88.40100.005230.8063.1019.50 3.80//6
    Kitada2012[35日本队列研究 CF患者60.00100.007216.7062.5019.7013.80//8
    Gochi2015[36日本队列研究 非HIV+NB型患者60.00100.0078231.5068.1019.8015.00100∶0药物6
    Kotilainen2015[37芬兰队列研究 非HIV患者60.00100.009930.6065.6020.3010.0065∶10∶25/8
    Morimoto2016[38日本队列研究 耐大环内酯患者60.00100.009025.6060.0017.4076.7034∶30∶36药物6
    Kumagai2016[39日本队列研究 非HIV患者71.00100.00486 40.3071.0019.9011.1081∶11∶8/5
    Ueyama2016[40日本队列研究 非HIV+气胸患者20.00 79.706947.3068.0017.0077.0036∶43∶20/6
    Asakura2017[41日本队列研究 非HIV患者85.00 88.00125 47.0060.00 19.5070.00//9
    Henkle2017[42美国队列研究 有/无ATS确诊患者60.00 83.10172 38.3067.00 /18.00//9
    Novosad2017[43美国队列研究 有/无ATS确诊患者60.00 84.20316 44.0064.60 /18.00//7
    Park2017[44韩国队列研究 非HIV+有/无胸膜炎患者44.00100.00209 45.9060.1020.4028.7059∶28∶13/8
    Ando2018[45日本队列研究 胸膜炎患者/100.001060.0069.20////5
    Asakura2018[46日本队列研究 ATS确诊患者36.00100.00260 19.6069.0019.0028.5073∶10∶17/7
    Furuuchi2018[47日本队列研究 有/无CPA患者60.00100.00361 40.2071.1019.7011.90302∶43∶16/9
    Goring2018[48欧洲队列研究 非HIV+非CF患者24.00100.00157 73.20/////8
    Griffith2018[49美国队列研究 所有患者6.00100.00335 30.7064.7021.20///8
    Eliseev2019[50 俄罗斯队列研究 所有患者/ 79.503956.0059.00/58.00//5
    Takeda2016[51日本队列研究 有/无CPA患者36.00 80.808258.5019.9019.9024.3058∶20∶4/8
      注:MAC肺病. 鸟分枝杆菌复合群肺病;RCT. 随机临床试验;HIV. 获得性免疫综合征;CPA. 慢性肺曲霉病;BMI. 体质指数;CF. 囊性纤维化;ATS. 美国胸科协会;/. 未提及
    下载: 导出CSV

    表  2  影响鸟分枝杆菌复合群肺病全因死亡率的危险因素

    Table  2.   Factors associated with MAC pulmonary disease all-cause mortality rate

      死亡率影响因素研究数目(项)(n=12)文献
    基线特点年龄≥65岁107,11,2829,36,
    3941,43,46
    男性711,17,2829,
    36,39,43
    BMI≤18.50 kg/m2628,36,39
    41,46
    吸烟史143
    肺部合并症228,43
    全身合并症211,28
    恶性疾病239,43
    其他机会性感染213,34
    影像学特征影像学检查有空洞617,2829,
    34,39,46
    病变累及多个肺叶117
    实验室检查基线痰涂片阳性229,34
    ESR≥50 mm/h228,36
    淋巴细胞计数
    <1000/μl
    213,39
    ALB<3.50 g/dL413,28,36,39
    CD4计数≤100×106113
    治疗不治疗146
    使用免疫抑制剂143
    使用环丝氨酸111
    使用乙胺丁醇129
    治疗药物中断113
    行“全肺切除术”141
      注:BMI. 体质指数;ESR. 红细胞沉降率;ALB. 血清白蛋白
    下载: 导出CSV
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  • 收稿日期:  2020-08-24
  • 网络出版日期:  2020-12-22
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