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[摘要]
目的 系统的评价应用含胸腺肽方案治疗耐多药肺结核(MDR-TB)的有效性及安全性,为优化治疗方案提供参考依据。方法 通过检索Pubmed、Embase、Cochrane Library、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普中文期刊全文数据库(VIP)和万方数据库自建库至2019年5月公开发表的含胸腺肽方案治疗MDR-TB的临床随机对照试验(RCTs),并根据Cochrane 5.1.0评价手册纳入文献进行质量评价,并使用Review Manager 5.3软件进行Meta-分析。结果 共纳入15个RCTs,计1 457名患者。Meta-分析结果显示:与对照组相比实验组痰菌阴转率[OR=3.24,95%CI(2.49~4.22),P<0.000 01]、病灶吸收率[OR=3.79,95%CI(2.03~7.05),P<0.000 1]和空洞闭合率[OR=2.73,95%CI(2.01~3.71),P<0.0000 1]均明显升高;而在肝功能受损率[OR=0.85,95%CI(0.55~1.34),P=0.49]、胃肠道反应率[OR=1.03,95%CI(0.62~1.72),P=0.90]和皮疹发生率[OR=0.77,95%CI(0.26~2.26),P=0.64]方面差异无统计学意义。结论 应用含胸腺肽联合抗结核药物方案可提高的MDR-TB治愈率,且总体安全性较好。
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[Abstract]
Objective To systematically evaluate the efficacy and safety of thymosin-containing regimens for the treatment of multidrug resistant tuberculosis (MDR-TB), providing more reference for future treatment of MDR-TB. Methods RCTs of thymosincontaining regimens for the treatment of MDR-TB were published by searching Pubmed, Embase, Cochrane Library CNKI, CBM, VIP and Wanfang database before May 2019 and based on the Cochrane 5.1.0 evaluation manual, the quality evaluation and metaanalysis of included literatures were performed using Review Manager 5.3 software. Results A total of 1 457 patients were enrolled in this study,consisting of 15 RCTs. Meta-analysis showed that the sputum negative conversion rate[OR=3.24, 95%CI(2.49-4.22), P<0.000 01], the lesion absorption rate[OR=3.79, 95%CI(2.03-7.05), P<0.000 1], and the cavity closure rate[OR=2.73, 95%CI (2.01-3.71), P<0.00001] were significantly higher in the experimental group than the control group. There were no significant difference in the liver damage rate[OR=0.85, 95%CI(0.55-1.34), P=0.49], the gastrointestinal reaction rate[OR=1.03, 95%CI (0.62-1.72), P=0.90], and the rash incidence rate[OR=0.77, 95%CI(0.26-2.26), P=0.64]. Conclusion The application of thymosin combined with anti-tuberculosis drugs can improve the cure rate of MDR-TB,and the overall safety is great.
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