微量营养素对肺结核患者营养不良、免疫和治疗效果的影响：系统评价和随机对照试验的荟萃分析。

The effect of micro-nutrients on malnutrition, immunity and therapeutic effect in patients with pulmonary tuberculosis: A systematic review and meta-analysis of randomised controlled trials.

机构信息

School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China; The Fourth People's Hospital of Nanning, HIV/AIDS Clinical Treatment Center of Guangxi, 530023, China.

The Second Nanning People's Hospital, 530031, China.

出版信息

Tuberculosis (Edinb). 2020 Dec;125:101994. doi: 10.1016/j.tube.2020.101994. Epub 2020 Sep 29.

DOI:10.1016/j.tube.2020.101994

PMID:33049436

Abstract

OBJECTIVE

Micro-nutrients are closely related to pulmonary tuberculosis (PTB). Most patients with PTB suffer from micro-nutrients deficiency. We aimed to evaluate the efficacy of micro-nutrients support on clinical therapy and chronic inflammation in patients with PTB.

METHODS

We searched Pubmed, Springer link, Web of Science, Cochrane, Wan Fang and CNKI databases for randomised controlled trials (RCTs). The patients with anti-TB treatments were divided into two groups, the control group with nutritional advice or placebo, and the experimental group with micro-nutrients support for more than 2 weeks. Two reviewers conducted data extraction and quality assessment of the studies independently, and ReviewManager 5.2 software was used to input and analyse the data. The dichotomous variable was expressed in the risk ratios (RRS) and 95% CI, the continuous data were expressed in the mean difference (MD) and 95% CI, and the heterogeneity of subgroup was evaluated by I (Kerantzas and Jacobs, Jr., 2017) [2] test.

RESULTS

A total of 13 trials (2847 participants) were included. First, micro-nutrients improved sputum smears or culture negative conversion rates (OR 0.16 0.03-0.77, 2.29; MD -2.36, -4.72~~-0.01, z = 1.97). Meanwhile, micro-nutrients support increased lymphocytes and decreased leukocytes, neutrophils, CRP and ESR (MD 0.20, 0.06-0.35, z = 2.78; MD -0.42, -0.65~~-0.18, z = 3.48; MD -0.66, -1.12~-0.20, z = 2.82). However it had not impact on body weight, MUAC, haemoglobin, albumin or monocytes (p > 0.05).

CONCLUSION

Micro-nutrients support can reduce chronic inflammation and improve sputum smears or culture conversions to contribute to anti-TB treatment.

摘要

目的

微量营养素与肺结核（PTB）密切相关。大多数 PTB 患者都存在微量营养素缺乏的问题。本研究旨在评估微量营养素支持对 PTB 患者临床治疗和慢性炎症的疗效。

方法

我们在 Pubmed、Springer Link、Web of Science、Cochrane、万方和中国知网数据库中检索了随机对照试验（RCT）。将接受抗结核治疗的患者分为两组，对照组接受营养建议或安慰剂，实验组接受超过 2 周的微量营养素支持。两位审查员独立进行数据提取和研究质量评估，并使用 ReviewManager 5.2 软件输入和分析数据。二分类变量表示为风险比（RRS）和 95%CI，连续数据表示为均数差（MD）和 95%CI，采用 I²（Kerantzas and Jacobs, Jr., 2017）[2]检验评估亚组的异质性。

结果

共纳入 13 项试验（2847 名参与者）。首先，微量营养素可提高痰涂片或培养转阴率（OR 0.16，0.03-0.77，2.29；MD -2.36，-4.72~~-0.01，z = 1.97）。同时，微量营养素支持可增加淋巴细胞，减少白细胞、中性粒细胞、CRP 和 ESR（MD 0.20，0.06-0.35，z = 2.78；MD -0.42，-0.65~~-0.18，z = 3.48；MD -0.66，-1.12~-0.20，z = 2.82）。但对体重、MUAC、血红蛋白、白蛋白或单核细胞无影响（p > 0.05）。