东非地区耐多药结核病的流行情况：系统评价和荟萃分析。
Prevalence of multidrug-resistant tuberculosis in East Africa: A systematic review and meta-analysis.
机构信息
Department of Biology, Faculty of Natural and Computational Sciences, Woldia University, Woldia, Ethiopia.
Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia.
出版信息
PLoS One. 2022 Jun 30;17(6):e0270272. doi: 10.1371/journal.pone.0270272. eCollection 2022.
BACKGROUND
The rate of multidrug-resistant tuberculosis is increasing at an alarming rate throughout the world. It is becoming an emerging public health problem in East Africa. The prevalence of multidrug-resistant tuberculosis among pulmonary tuberculosis positive individuals in the region has not been thoroughly investigated.
AIM
The aim of this systematic review and meta-analysis is to estimate the pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed and previously treated pulmonary tuberculosis cases in East African countries.
METHODS
English published articles were systematically searched from six electronic databases: PubMed, EMBASE, Scopus, Science direct, Web of Science, and Google scholar. The pooled prevalence of multidrug-resistant tuberculosis and associated risk factors were calculated using Der Simonian and Laird's random Effects model. Funnel plot symmetry visualization confirmed by Egger's regression asymmetry test and Begg rank correlation methods was used to assess publication bias. A total of 16 articles published from 2007 to 2019 were included in this study. STATA 14 software was used for analysis.
RESULTS
Out of 1025 articles identified citations, a total of 16 articles were included in final meta-analysis. The pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed tuberculosis cases and previously treated tuberculosis patients was 4% (95%CI = 2-5%) and 21% (95%CI: 14-28%), respectively. Living conditions, lifestyles (smoking, alcohol use, and drug abuse), previous medical history, diabetes history, and human immunodeficiency virus infection were risk factors contributing to the higher prevalence of multidrug-resistant tuberculosis in East Africa.
CONCLUSION
The review found a significant prevalence of multidrug-resistant tuberculosis in the region. An early diagnosis of tuberculosis and rapid detection of drug-resistant Mycobacterium tuberculosis is a critical priority to identify patients who are not responding to the standard treatment and to avoid transmission of resistant strains. It is also very important to strengthen tuberculosis control and improve monitoring of chemotherapy.
背景
在全球范围内，耐多药结核病的发病率正在以惊人的速度上升。它正在成为东非地区一个新出现的公共卫生问题。该地区肺结核阳性人群中耐多药结核病的患病率尚未得到彻底调查。
目的
本系统评价和荟萃分析的目的是估计东非国家新诊断和既往治疗的肺结核病例中耐多药结核病的 pooled 患病率。
方法
从六个电子数据库（PubMed、EMBASE、Scopus、Science Direct、Web of Science 和 Google Scholar）系统地搜索了英文发表的文章。使用 Der Simonian 和 Laird 的随机效应模型计算耐多药结核病的 pooled 患病率和相关的危险因素。Egger 回归不对称检验和 Begg 等级相关方法的漏斗图对称性可视化用于评估发表偏倚。本研究共纳入了 2007 年至 2019 年发表的 16 篇文章。使用 STATA 14 软件进行分析。
结果
在 1025 篇识别出的引文文章中，共有 16 篇文章被纳入最终的荟萃分析。新诊断肺结核病例和既往治疗肺结核患者中耐多药结核病的 pooled 患病率分别为 4%（95%CI = 2-5%）和 21%（95%CI：14-28%）。生活条件、生活方式（吸烟、饮酒和吸毒）、既往病史、糖尿病史和人类免疫缺陷病毒感染是导致东非地区耐多药结核病患病率较高的危险因素。
结论
该综述发现该地区耐多药结核病的患病率较高。早期诊断结核病并快速检测耐药结核分枝杆菌是一个关键的优先事项，以确定对标准治疗无反应的患者，并避免耐药菌株的传播。加强结核病控制和改善化疗监测也非常重要。
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