中国结核分枝杆菌潜伏感染预防性治疗接受度及影响因素Meta分析

doi:10.19983/j.issn.2096-8493.20250091

摘要/Abstract

摘要：

目的: 系统评价中国结核分枝杆菌潜伏感染人群预防性治疗接受度及影响因素,为公共卫生部门开展结核分枝杆菌潜伏感染预防性治疗提供依据。方法: 检索中国知网、万方数据知识服务平台、维普、中国生物医学文献数据库,以及PubMed、Web of Science、Embase、The Cochrane Library等中英文数据库,收集建库至2025年2月19日期间发表的关于中国结核分枝杆菌潜伏感染预防性治疗相关的研究。由2名研究者独立完成文献筛选、数据提取、质量评估,采用Stata 14.0软件进行Meta分析,计算其合并接受度,分析相关影响因素。结果: 纳入16篇文献,总样本量8806例。结果显示,中国结核分枝杆菌潜伏感染者预防性治疗接受度为66.2%(95%CI: 56.9%~74.9%)。亚组分析结果显示,调查地区为西部(70.0%)、2020年以前发表(68.7%)的研究报告接受度更高。人口学特征分析显示,女性(68.4%)、年龄18~45岁(80.1%)、文化程度为初中及以下(77.7%)的潜伏感染者对治疗的接受度较高,肺结核患者密切接触者预防性治疗的接受度最高(79.5%),其他高危人群次之(71.9%),学校结核病筛查发现的结核分枝杆菌潜伏感染学生的接受度最低(51.4%)。多因素分析发现,女性(OR=1.05, 95%CI:1.01~1.16)、职业为学生(OR=1.23, 95%CI:1.04~1.52)或体力劳动者(OR=1.65, 95%CI:1.39~1.93)、良好的疾病知识水平(OR=1.18, 95%CI:1.07~1.29)、有卡介苗接种史(OR=1.42, 95%CI:1.01~2.08)等因素为保护因素,而寄宿制学生身份(OR=0.61, 95%CI:0.35~0.88)和较长治疗方案周期(OR=0.38, 95%CI:0.04~0.71)为危险因素。结论: 中国结核分枝杆菌潜伏感染人群预防性治疗接受度有待进一步提高,加强健康宣教,破解污名化顾虑,提高疾病知识水平,并推广短程方案,可有效提升其预防性治疗接受度。

关键词: 结核, 分枝杆菌感染, 预防医学, 病人接受卫生保健的程度, 系统分析

Abstract:

Objective: To systematically evaluate the acceptance rate of preventive treatment and its influencing factors among individuals with latent tuberculosis infection (LTBI) in China, and to provide evidence for public health departments to implement targeted LTBI interventions. Methods: Chinese and English databases (including CNKI, Wanfang, VIP, CBM, PubMed, Web of Science, Embase, and The Cochrane Library) were searched for studies published up to February 19, 2025, related to preventive treatment for LTBI in China. Two researchers independently screened literature, extracted data, and assessed study quality. Stata 14.0 was used for Meta-analysis to calculate the pooled acceptance rate and analyze influencing factors. Results: A total of 16 studies were included, involving 8806 participants. The pooled acceptance rate of preventive treatment among LTBI individuals in China was 66.2% (95%CI: 56.9%-74.9%). Subgroup analysis showed higher acceptance rates in western regions (70.0%) and in studies published before 2020 (68.7%). Demographic analysis revealed higher acceptance among females (68.4%), individuals aged 18-45 years (80.1%), and those with education levels of junior high school or below (77.7%). Acceptance was highest among close contacts of pulmonary tuberculosis patients (79.5%), followed by other high-risk populations (71.9%), and lowest among students identified with LTBI through school screening (51.4%). Multivariable analysis identified the following protective factors: females (OR=1.05, 95%CI: 1.01-1.16), being a student (OR=1.23, 95%CI: 1.04-1.52) or manual laborers (OR=1.65, 95%CI: 1.39-1.93), having good knowledge of the disease (OR=1.18, 95%CI: 1.07-1.29), and a history of BCG vaccination (OR=1.42, 95%CI: 1.01-2.08). Risk factors included being boarding students (OR=0.61, 95%CI: 0.35-0.88) and longer treatment regimens (OR=0.38, 95%CI: 0.04-0.71). Conclusion: The acceptance rate of preventive treatment among individuals with LTBI in China remains suboptimal. Strengthening health education, addressing stigma, improving disease awareness, and promoting shorter treatment regimens may help enhance treatment uptake in key populations.

Key words: Tuberculosis, Mycobacterium infections, Preventive medicine, Patient acceptance of health care, Systems analysis

中图分类号:

R183.3

杨宇兰, 万彬, 赵霞, 沈靖, 姚蓉, 余巧林, 何婷. 中国结核分枝杆菌潜伏感染预防性治疗接受度及影响因素Meta分析[J]. 结核与肺部疾病杂志, 2026, 7(1): 21-29. doi: 10.19983/j.issn.2096-8493.20250091

Yang Yulan, Wan Bin, Zhao Xia, Shen Jing, Yao Rong, Yu Qiaolin, He Ting. Acceptance of preventive treatment for latent tuberculosis infection and its influencing factors:a Meta-analysis[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(1): 21-29. doi: 10.19983/j.issn.2096-8493.20250091

图/表 9

表1

PubMed 检索策略

步骤	检索式
#1	(″latent tuberculosis″[MeSH])
#2	(″latent tuberculosis″[Title/Abstract] OR ((″Tuberculosis″[MeSH Terms] OR ″tuberculosis″[All Fields] OR ″tuberculosis″[All Fields] OR ″tuberculosis s″[All Fields]) AND ″latent″[Title/Abstract]) OR ″tuberculosis latent″[Title/Abstract] OR ″latent tuberculosis infection″[Title/Abstract] OR ″infection latent tuberculosis″[Title/Abstract] OR ″infections latent tuberculosis″[Title/Abstract] OR ″latent tuberculosis infections″[Title/Abstract] OR ″tuberculosis infection latent″[Title/Abstract] OR ((″tuberculosis″[All Fields] OR ″tuberculosis″[MeSH Terms] OR ″tuberculosis″[All Fields] OR ″tuberculosis″[All Fields] OR ″tuberculosis″[All Fields]) AND ″infections latent″[Title/Abstract]) OR ″LTBI″[Title/Abstract]))
#3	#1 OR #2
#4	(″prevention and control″[MeSH Subheading]
#5	(″preventive treatment″[Title/Abstract] OR ″preventive therapy″[Title/Abstract] OR ″prophylaxis″[Title/Abstract] OR ″TPT″[Title/Abstract] OR ″ Rifapentine″[Title/Abstract] OR ″3HP″[Title/Abstract] OR ″3HR″[Title/Abstract] OR ″Isoniazid″[Title/Abstract])
#6	#4 OR #5
#7	(″intention″[Title/Abstract] OR ″intentional″[Title/Abstract] OR ″intent″[Title/Abstract] OR ″intend″[Title/Abstract] OR ″willingness″[Title/Abstract] OR ″will″[Title/Abstract] OR ″utilization″[Title/Abstract] OR ″utilisation″[Title/Abstract] OR ″acceptance″[Title/Abstract] OR ″acceptability″[Title/Abstract] OR ″adoption″[Title/Abstract] OR ″uptake″[Title/Abstract] OR ″usage″[Title/Abstract] OR ″use″[Title/Abstract] OR ″awareness″[Title/Abstract] OR ″adherence″[Title/Abstract] OR ″knowledge″[Title/Abstract] OR ″attitude″[Title/Abstract] OR ″perception″[Title/Abstract] OR ″feasibility″[Title/Abstract])
#8	#3 AND #6 AND #7

表1

图1

表2

图2

表3

表4

图3

图4

图5

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第一作者	发表年份	研究类型	研究地区	研究对象	符合治疗者(名)	接受治疗者(名)	接受度 (%)	质量评价(分)	影响因素
Li^[8]	2018	A	上海	a	560	487	86.96	5	⑦12
Huang^[9]	2018	B	广州	b	362	156	43.09	6	-
祖筱雯^[10]	2020	A	河南、湖南、重庆	a	991	633	63.87	5	①②③④⑤⑥⑦⑨
任哲雯^[11]	2020	A	河南、湖南、重庆	a	1033	788	76.28	6	①②③④⑤⑥⑦⑨
张霞^[12]	2021	A	上海	c	74	45	60.81	5	①③⑦
Chiu^[13]	2022	B	台湾	c	371	274	73.85	6	-
玛依沙·达肯^[14]	2023	B	乌鲁木齐	a	435	306	70.34	6	①②③④⑦
Yuan^[15]	2023	B	山东	b	723	287	39.70	6	①②⑧⑩
Yuan^[16]	2023	A	山东	b	1547	723	46.73	8	①
王展^[17]	2024	B	江苏	b	347	164	47.30	6	①②⑧⑨12
张静^[18]	2024	A	新疆	a	516	497	96.32	7	①②③④⑤⑥⑨⑩11
Xie^[19]	2024	A	北京	c	200	153	76.50	6	-
冯彬^[20]	2024	A	江苏	b	368	253	68.75	7	①④⑦⑩11
黄涛^[21]	2024	A	新疆	a	663	497	74.96	6	①②③④⑤⑥⑦⑨⑩12
马作丽^[22]	2024	A	安徽	b	158	77	48.73	6	①②③④⑨
彭晓唯^[23]	2025	A	贵州	b	458	299	83.99	7	①②③⑧11

亚组分析	纳入文献数 (篇)	异质性检验结果		效应模型	预防性治疗接受度 (95%CI)
亚组分析	纳入文献数 (篇)	P值	I²值	效应模型	预防性治疗接受度 (95%CI)
性别
男性	12^{[10-12,14-18,20-23]}	<0.01	97.9	随机	64.4(52.6~75.5)
女性	12^{[10-12,14-18,20-23]}	<0.01	97.8	随机	68.4(57.6~78.2)
年龄组(岁)
≤18	6^{[10-11,14,18,21,23]}	<0.01	91.6	随机	77.8(67.5~86.7)
18~45	5^{[10-11,14,18,21]}	<0.01	97.2	随机	80.1(65.0~91.7)
≥45	5^{[10-11,14,18,21]}	<0.01	94.9	随机	77.1(67.3~85.6)
文化程度
初中及以下	8^{[10-12,14,18,21-23]}	<0.01	97.1	随机	77.7(67.2~86.6)
初中以上	8^{[10-12,14,18,21-23]}	<0.01	94.3	随机	65.5(57.8~80.0)
研究人群
a	6^{[8,10-11,14,18,21]}	<0.01	98.5	随机	79.5(68.7~88.5)
b	7^{[9,15-17,20,22-23]}	<0.01	95.8	随机	51.4(43.4~59.5)
c	3^[12-13,19]	<0.01	96.5	随机	71.9(64.7~78.6)
地区^[24]
东部	9^{[8-9,12-13,19-20]}	<0.01	98.6	随机	61.1(48.4~73.1)
西部	5^{[8,10-11,14,18,21]}	<0.01	98.7	随机	70.0(51.9~85.4)
中部	3^[10-11,22]	<0.01	98.1	随机	63.8(50.7~76.0)
发表年份
2020年以前	4^[8-11]	<0.01	98.8	随机	68.7(52.4~82.9)
2020年以后	12^[12-23]	<0.01	98.8	随机	65.4(53.6~76.3)
研究类型
横断面研究	11^{[8,10-12,16,18-23]}	<0.01	98.8	随机	71.0(60.2~80.8)
队列研究	5^[9,13-15,17]	<0.01	97.9	随机	55.1(40.4~69.4)

影响因素	纳入文献 (篇)	异质性检验结果		效应模型	Meta分析结果
影响因素	纳入文献 (篇)	P值	I²(%)	效应模型	OR(95%CI)	P值
一般因素
性别(女)	12^{[10-12,14 -18,20 -23]}	<0.05	43.4	固定	1.05(1.01~1.16)	0.048
年龄	6^{[10-11,14,18,21,23]}	<0.05	11.4	固定	0.84(0.65~1.04)	0.336
文化程度	8^{[10-12,14,18,21 -23]}	<0.05	52.4	随机	0.76(0.54~0.98)	0.032
家庭经济收入	7^{[10-11,14,18,20 -22]}	<0.05	78.8	随机	0.89(0.57~1.22)	0.964
职业因素
学生	4^{[10-11,18,21]}	0.07	52.1	随机	1.23(1.04~1.52)	<0.05
体力劳动者	4^{[10-11,18,21]}	<0.05	80.1	随机	1.65(1.39~1.93)	<0.05
寄宿学生	3^[15,17,23]	<0.05	92.1	随机	0.61(0.35~0.88)	<0.05
疾病相关因素
疾病知识具备者	7^{[8,10 -12,14,20 -21]}	<0.05	82.4	随机	1.18(1.07~1.29)	<0.05
吸烟者	4^{[15,18,20 -21]}	0.057	60.0	随机	1.17(0.66~2.08)	0.588
卡介苗接种者	3^[18,20,23]	0.110	54.8	随机	1.42(1.01~2.08)	0.042
治疗周期长	3^[8,17,21]	<0.05	89.5	随机	0.38(0.04~0.71)	0.090
结核病患者接触者	6^{[10-11,17 -18,21 -22]}	<0.05	67.7	随机	0.77(0.44~1.09)	0.320