常规降糖抗结核联合胸腺肽α1治疗肺结核并发糖尿病患者效果的Meta分析

doi:10.19983/j.issn.2096-8493.2024005

摘要/Abstract

摘要：

目的：探讨常规降糖抗结核治疗联合胸腺肽α1在肺结核并发糖尿病患者中的应用效果。方法：系统检索PubMed、Web of Science、Embase、中国知网、万方数据库等中自2010年1月1日至2022年6月30日中英文相关文献,中文检索词包括:胸腺肽α1、Tα1、结核、糖尿病;英文检索词包括:Thymosin alpha 1、Tα1、Tuberculosis、Diabetes mellitus、Diabetes。收集使用常规降糖抗结核治疗及常规降糖抗结核联合胸腺肽α1治疗肺结核并发糖尿病患者的随机对照试验研究结果。结果：总计检索得到文献1117篇,最终纳入研究13篇;共纳入685例患者,其中观察组(联合胸腺肽α1治疗)335例,对照组(常规降糖抗结核治疗)350例。Meta分析显示:观察组患者的治疗有效率[OR(95%CI)=4.08(2.77~6.02)]、痰菌阴转率[OR(95%CI)=4.61(3.21~6.63)]、病灶吸收率[OR(95%CI)=5.06(3.19~8.04)]均明显优于对照组;观察组患者治疗后的CD4⁺T细胞水平[标准化均数差(SMD)=2.07,95%CI:1.37~2.77,P<0.001]和CD3⁺T细胞水平[SMD(95%CI)=2.33(0.98~3.67),P=0.001]均明显优于对照组;治疗后观察组患者的CD8⁺T细胞水平明显低于对照组[SMD(95%CI)=-2.21(-2.95~-1.48),P<0.001],CD4⁺/CD8⁺比值明显升高[SMD(95%CI)=1.25(0.73~1.77),P<0.001]。结论：常规降糖抗结核联合胸腺肽α1治疗肺结核并发糖尿病患者能够提高治疗有效率、病灶吸收率及痰菌阴转率;通过治疗,患者的CD4⁺、CD3⁺T细胞水平和CD4⁺/CD8⁺比值均有所提高。

关键词: 结核,肺, 糖尿病, 胸腺激素类, 治疗结果, Meta分析

Abstract:

Objective: To evaluate the efficacy of conventional hypoglycemic and anti-tuberculosis therapy combined with thymosin α1 in pulmonary tuberculosis patients complicated with diabetes mellitus. Methods: Relevant literature was searched for in both Chinese and English from PubMed, Web of Science, Embase, CNKI, Wanfang Database, etc. from January 1, 2010 to June 30, 2022, with Chinese search terms including thymosin α1, Tα1, tuberculosis, diabetes, and the English search terms including Thymosin alpha 1, Tα1, Tuberculosis, Diabetes mellitus, Diabetes. he results of randomized controlled trial of pulmonary tuberculosis patients complicated with diabetes were collected, all the patients were treated with conventional hypoglycemic and anti-tuberculosis therapy combined with thymosin α1. Results: A total of 1117 references were retrieved, and 13 were ultimately included in the study; the 685 included patients were divided into the observation group (n=335, combined with thymosin α1) and the control group (n=350, conventional hypoglycemic and anti-tuberculosis treatment). Meta analysis showed that, of the observation group, the treatment efficacy rate (OR (95%CI)=4.08 (2.77-6.02)), sputum negative conversion rate (OR (95%CI)=4.61 (3.21-6.63)), and lesion absorption rate (OR (95%CI)=5.06 (3.19-8.04)) were significantly better than those of the control group; the CD4⁺T cell levels after treatment (standardized mean difference (SMD)=2.07, 95%CI: 1.37-2.77, P<0.001) and CD3⁺T cell levels (SMD (95%CI)=2.33 (0.98-3.67), P=0.001) were significantly better than those in the control group; after treatment, the CD8⁺T cell level was significantly lower than that in the control group (SMD (95%CI)=-2.21 (-2.95--1.48), P<0.001), and the CD4⁺/CD8⁺ ratio was significantly increased (SMD (95%CI)=1.25 (0.73-1.77), P<0.001). Conclusion: Conventional hypoglycemic and anti-tuberculosis combination with thymosin α1 treatment for pulmonary tuberculosis patients complicated with diabetes could improve the treatment efficiency, focus absorption rate and sputum negative conversion rate; with the treatment, the patient’s CD4⁺, CD3⁺T cell levels, and CD4⁺/CD8⁺ratio have all increased.

Key words: Tuberculosis, pulmonary, Diabetes mellitus, Thymus hormones, Treatment outcome, Meta-analysis

中图分类号:

R521

李丹, 张玉华, 陈盛玉. 常规降糖抗结核联合胸腺肽α1治疗肺结核并发糖尿病患者效果的Meta分析[J]. 结核与肺部疾病杂志, 2024, 5(2): 148-157. doi: 10.19983/j.issn.2096-8493.2024005

Li Dan, Zhang Yuhua, Chen Shengyu. Meta-analysis of conventional hypoglycemic and anti-tuberculosis therapy combined with thymosin α1 in the treatment of pulmonary tuberculosis complicated with diabetes[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(2): 148-157. doi: 10.19983/j.issn.2096-8493.2024005

图/表 7

表1

纳入文献的基本特征

文献编号	发表年份	抽样时间	组别	例数	病程 (月, $x ˉ$ ±s)	年龄 (岁, $x ˉ$ ±s)	胸腺肽α1 治疗疗程	男性患者(例)	研究类型	结果评估
文献[6]	2015	2011年3月至 2014年3月	观察组	27	4.95±3.41	66.73±10.15	6个月	15	随机对照试验	①②③ ④⑤⑥
			对照组	27	4.95±3.41	66.73±10.15		15
文献[15]	2020	2018年9月至 2019年12月	观察组	32	6.41±0.94	52.31±7.34	6个月	17	随机对照试验	②③④ ⑤⑥
			对照组	32	6.56±0.88	51.89±7.61		18
文献[16]	2012	2008年1月至 2009年6月	观察组	68	4.70±3.50	53.80±11.60	3个月	44	病例对照研究	②③④ ⑤⑥
			对照组	88	5.20±3.10	52.30±12.60		58
文献[7]	2019	2016年3月至 2018年1月	观察组	53	3.65±1.02	53.26±4.11	2个月	20	随机对照试验	①②⑤ ⑥⑦
			对照组	53	3.81±1.12	54.11±4.26		23
文献[17]	2014	2008年2月至 2012年4月	观察组	38	6~18	41.20±6.50	6个月	28	随机对照试验	②③⑤ ⑥⑦
			对照组	38	5~15	42.70±5.70		26
文献[8]	2021	2018年10月至 2020年8月	观察组	40	4.82+1.16	54.26±9.92	3个月	25	随机对照试验	①②③ ⑤⑥⑦
			对照组	40	4.91±1.09	53.89±9.75		23
文献[9]	2018	2015年3月至 2016年12月	观察组	42	9.80±2.30	44.50±6.20	6个月	28	随机对照试验	①②③ ④⑤⑥
			对照组	42	9.80±2.20	44.70±6.10		26
文献[10]	2016	2014年5月至 2016年5月	观察组	26	8.94±3.12	55.01±8.13	6个月	12	随机对照试验	①⑤⑥
			对照组	26	9.07±3.25	54.26±8.71		16
文献[11]	2017	2016年1—12月	观察组	63	9.21±3.81	55.32±8.32	6个月	36	随机对照试验	①⑤⑥
			对照组	63	9.07±3.25	54.62±8.17		38
文献[12]	2020	2018年1—10月	观察组	43	15.64±3.82	63.77±8.55	6个月	27	随机对照试验	①②③ ④⑤⑥
			对照组	43	16.10±4.06	61.70±6.50		23
文献[13]	2021	2017年12月至 2019年6月	观察组	40	5.40±1.50	68.90±4.60	3个月	24	随机对照试验	①⑤⑥
			对照组	40	5.30±1.60	68.20±4.30		23
文献[18]	2021	2016年1月至 2019年12月	观察组	43	1.75±0.34	50.23±2.45	6个月	23	病例对照研究	②④⑤ ⑥⑦
			对照组	43	1.80±0.31	50.31±2.40		21
文献[14]	2022	2017年1月至 2018年1月	试验组	60	6.85±2.78	46.68±9.44	3个月	36	随机对照试验	①②③④ ⑤⑥⑦
			对照组	60	6.77±2.12	47.53±9.62		40

表1

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图6

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