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目的评价直接面视下督导化疗(DOT)对结核病病例管理的效果。方法通过《中国全文期刊网》(CNKI)、万方数据库和Medline数据库检索1994-2004年关于DOT有关文献和资料,并进行系统评价,包括定量分析(Meta分析)和定性分析;评价指标为治愈率。结果共检索204篇文献,入选120篇。(1)管理措施:全程督导组与全程管理组治愈率合并后率差RD值(95%CI)为0.14(0.06~0.22),P<0.00001。按全程管理执行严格程度进行分层分析,全程督导和管理严格的全程管理组差异无统计学意义(P=0.06),RD值(95%CI)为0.02(0.00~0.03),全程督导与未提及是否严格的全程管理组差异有统计学意义(P=0.004),RD值(95%CI)为0.18(0.06~0.30),不严格组差异有统计学意义(P<0.05),RD值(95%CI)为0.16(0.07~0.24)。全程督导组与自服药组差异有统计学意义(P=0.002),RD值(95%CI)为0.24(0.10~0.38)。(2)化疗方案:短疗程与长疗程化疗方案治愈率差异有统计学意义(P=0.003),合并RD值(95%CI)为0.04(0.01~0.07)。结论只要管理严格,强化对结核病病例的不同管理模式,如全程督导和全程管理,可以使患者达到相同的治疗依从性。患者的依从性与化疗方案、给药方式(每日给药或间歇给药)等因素有关。
Objective To evaluate the effect of direct chemotherapy (DOT) on tuberculosis case management under direct visualization. Methods The documents and data about DOT from 1994 to 2004 were retrieved from CNKI, Wanfang database and Medline database, and were systematically evaluated, including quantitative analysis (Meta-analysis) and qualitative analysis. The evaluation index was cured rate. Results A total of 204 articles were retrieved and 120 articles were included. (1) Management measures: The rate of difference RD (95% CI) was 0.14 (0.06-0.22), P <0.00001 after the merger of the whole supervision group and the whole management group. According to the strict management of the whole process of stratified analysis, the whole process of supervision and management of strict management team had no significant difference (P = 0.06), RD (95% CI) was 0.02 (0.00 ~ 0.03) There was a significant difference in the strict management group (P = 0.004), RD (95% CI) was 0.18 (0.06-0.30), and there was a significant difference in the non-strict group (P <0.05) (95% CI) was 0.16 (0.07-0.24). There was a significant difference between the whole supervision group and self-medication group (P = 0.002). The RD value (95% CI) was 0.24 (0.10-0.38). (2) Chemotherapy regimen: There was significant difference in cure rate between short course and long course of chemotherapy (P = 0.003). The combined RD value (95% CI) was 0.04 (0.01-0.07). Conclusion As long as the management is rigorous and the different management modes of TB cases are strengthened, such as full supervision and overall management, the patients can achieve the same treatment compliance. Patient compliance is related to chemotherapy regimens, modes of administration (daily or intermittent) and other factors.