Fan Huanhuan, Wu Fan, Liu Jing, Zeng Weifeng, Zheng Silan, Tian Heshen, Li Haiqing, Yang Huajing, Wang Zihui, Deng Zhishan, Peng Jieqi, Zheng Youlan, Xiao Shan, Hu Guoping, Zhou Yumin, Ran Pixin
The Third Clinical College, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Ann Transl Med. 2021 Mar;9(5):390. doi: 10.21037/atm-20-4576.
BACKGROUND: Prior pulmonary tuberculosis (TB) can cause permanent changes in lung anatomy and is associated with lung function loss. However, it remains unclear whether pulmonary function impairment owing to TB is associated with airflow obstruction, the hallmark of chronic obstructive pulmonary disease (COPD). The aim of this systematic review and meta-analysis was to assess the association and quantify the magnitudes of association between pulmonary TB and COPD, and to evaluate the prevalence of COPD in patients with prior pulmonary TB. METHODS: We searched the PubMed, Embase, and Web of Science databases for studies published from inception to January 1, 2020. Pooled effect sizes were calculated according to a random effects model or fixed effect model depending on heterogeneity. Specific subgroups (different diagnostic criteria, smoking status, income level) were examined. RESULTS: A total of 23 articles were included in this study. Compared with controls, patients with pulmonary TB had an odds ratios (ORs) of 2.59 [95% confidence interval (CI): 2.12-3.15; P<0.001] for developing COPD. In jackknife sensitivity analyses, the increased risk of prior pulmonary TB remained consistent for COPD; when the meta-analysis was repeated and one study was omitted each time, the ORs and corresponding 95% CIs were greater than 2. Funnel plots of ORs with Egger's linear regression (t=2.00, P=0.058) and Begg's rank correlation (Z=0.75, P=0.455) showing no significant publication bias. Subgroup analysis showed that the same conclusion was still present in never smokers (ORs 2.41; 95% CI: 1.74-3.32; P<0.001), patients with pulmonary TB diagnosed using chest X-ray (ORs 2.47; 95% CI: 1.23-4.97; P<0.001), and low- and middle-income country (LMIC) settings (ORs 2.70; 95% CI: 2.08-3.51; P<0.001). The pooled prevalence of COPD in patients with prior pulmonary TB was 21% (95% CI: 16-25%; P<0.001). CONCLUSIONS: Individuals with prior pulmonary TB have an increased risk and high prevalence of COPD. Future studies identifying the underlying mechanisms for TB-associated COPD and therapeutic strategies are required.
背景：既往肺结核可导致肺部解剖结构发生永久性改变，并与肺功能丧失相关。然而，尚不清楚肺结核所致的肺功能损害是否与气流受限有关，而气流受限是慢性阻塞性肺疾病（COPD）的标志。本系统评价和荟萃分析的目的是评估肺结核与COPD之间的关联，并量化其关联强度，同时评估既往肺结核患者中COPD的患病率。 方法：我们检索了PubMed、Embase和Web of Science数据库，以获取从数据库建立至2020年1月1日发表的研究。根据异质性情况，采用随机效应模型或固定效应模型计算合并效应量。对特定亚组（不同诊断标准、吸烟状况、收入水平）进行了分析。 结果：本研究共纳入23篇文章。与对照组相比，肺结核患者患COPD的比值比（OR）为2.59[95%置信区间（CI）：2.12 - 3.15；P<0.001]。在逐一剔除法敏感性分析中，既往肺结核患者患COPD的风险增加仍然一致；每次重复荟萃分析并剔除一项研究时，OR及相应的95%CI均大于2。采用Egger线性回归（t = 2.00，P = 0.058）和Begg秩相关（Z = 0.75，P = 0.455）的OR漏斗图显示无显著发表偏倚。亚组分析表明，从不吸烟者（OR 2.41；95%CI：1.74 - 3.32；P<0.001）、采用胸部X线诊断肺结核的患者（OR 2.47；95%CI：1.23 - 4.97；P<0.001）以及低收入和中等收入国家（LMIC）地区的患者（OR 2.70；95%CI：2.08 - 3.51；P<0.001）中也得出了相同结论。既往肺结核患者中COPD的合并患病率为21%（95%CI：16 - 25%；P<0.001）。 结论：既往有肺结核的个体患COPD的风险增加且患病率较高。未来需要开展研究以确定与肺结核相关的COPD的潜在机制和治疗策略。
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