Namale Phiona E, Abdullahi Leila H, Fine Stacey, Kamkuemah Monika, Wilkinson Robert J, Meintjes Graeme
Department of Medicine, University of Cape Town, Cape Town, South Africa.
Vaccines for Africa Initiative, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Future Microbiol. 2015;10(6):1077-99. doi: 10.2217/fmb.15.9.
Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) was first described almost two decades ago. We undertook this systematic review and meta-analysis to collate findings across studies that have reported the incidence, clinical features, management and outcomes of paradoxical TB-IRIS. Forty studies that cumulatively reported 1048 paradoxical TB-IRIS cases were included. The pooled estimated incidence among patients with HIV-associated TB initiating antiretroviral therapy was 18% (95% CI: 16-21%). Frequent features were pulmonary and lymph node involvement. Hospitalization occurred in 25% (95% CI: 19-30%). In studies that reported treatment, corticosteroids were prescribed more frequently (38%; 95% CI: 27-48%) than nonsteroidal anti-inflammatory drugs (28%; 95% CI: 2-53%). Case fatality was 7% (95% CI: 4-11%), but death attributed to TB-IRIS occurred in 2% of cases (95% CI: 1-3%).
矛盾性结核免疫重建炎症综合征（TB-IRIS）于近二十年前首次被描述。我们进行了这项系统评价和荟萃分析，以整理各项研究中有关矛盾性TB-IRIS的发病率、临床特征、管理及结局的研究结果。纳入了40项累计报告1048例矛盾性TB-IRIS病例的研究。在开始抗逆转录病毒治疗的HIV相关结核病患者中，汇总估计发病率为18%（95%置信区间：16%-21%）。常见特征为肺部和淋巴结受累。25%的患者需要住院治疗（95%置信区间：19%-30%）。在报告了治疗情况的研究中，使用皮质类固醇的频率（38%；95%置信区间：27%-48%）高于非甾体类抗炎药（28%；95%置信区间：2%-53%）。病死率为7%（95%置信区间：4%-11%），但因TB-IRIS导致的死亡占病例的2%（95%置信区间：1%-3%）。
