Are intestinal helminths playing a positive role in tuberculosis risk? A systematic review and meta-analysis

BackgroundCo-infection of intestinal helminthic infections (IHIs) and tuberculosis (TB) has appeared as a public health issue, especially in developing countries. Some recent studies have been carried out on the possible relevance of IHIs to TB. The current systematic review and meta-analysis was conducted to assess the prevalence and odds ratio (OR) of IHIs among TB patients and clarify the relationship between IHIs and TB disease.MethodsFor the purpose of the study, five English databases including PubMed, Science Direct, Scopus, Web of Science (ISI), and Google scholar were searched (up to January 30, 2019) in order to find the related studies. Random-effects meta-analysis model was used to estimate the pooled prevalence, odds ratio (OR), and 95% confidence interval (CI). Inclusion and exclusion criteria were applied.ResultsA total of 20 studies including 10 studies with case-control design (2217 patients and 2520 controls) and 10 studies with cross-sectional design (a total of 2415 participants) met the eligibility criteria. As shown by the random-effects model, the pooled prevalence of IHIs in TB patients was estimated to be 26% (95% CI, 17–35%; 1249/4632). The risk of IHI was higher in TB patients compared to controls but this was not statistically significant. However, according to genus/species, the pooled OR of Strongyloides stercoralis (S. stercoralis) (OR, 2.68; 95% CI, 1.59–4.54) had a significantly higher risk in TB patients compared to controls. Nevertheless, the results of random effects model showed no statistically significant association between overall pooled OR of IHIs in TB patients compared to controls in case-control studies (OR, 1; 95% CI, 0–1).ConclusionsIt is highly recommended that more precise studies should be carried out by researchers in order to better understand this association. Also, it is of great importance to include the periodic screenings for IHIs in the routine clinical care of these patients.背景 肠道蠕虫感染（intestinal helminthic infections, IHIs）与结核病（tuberculosis, TB）的合并感染已成为一项公共卫生问题，在发展中国家尤为突出。目前已有多项针对肠道蠕虫感染与结核病潜在相关性的研究问世。本系统评价与荟萃分析旨在评估结核病患者肠道蠕虫感染的患病率及比值比（odds ratio, OR），并阐明二者间的关联。 方法 为开展本研究，我们检索了PubMed、Science Direct、Scopus、Web of Science（ISI）及Google Scholar共5个英文数据库，检索时限截至2019年1月30日，以获取相关研究。本研究采用随机效应荟萃分析模型，合并估算患病率、比值比（OR）及95%置信区间（confidence interval, CI），并严格遵循纳入与排除标准进行文献筛选。 结果 最终共有20项研究符合纳入标准，其中10项为病例对照研究（涉及2217例患者与2520例对照），10项为横断面研究（共纳入2415名参与者）。经随机效应模型分析，结核病患者肠道蠕虫感染的合并患病率为26%（95%CI：17%~35%；1249/4632）。与对照组相比，结核病患者的肠道蠕虫感染风险更高，但该差异未达到统计学显著性。然而，按属/种分层分析显示，粪类圆线虫（Strongyloides stercoralis, S. stercoralis）的合并比值比为2.68（95%CI：1.59~4.54），结核病患者的感染风险显著高于对照组。不过，病例对照研究的整体合并比值比分析显示，结核病患者与对照组的肠道蠕虫感染总体合并比值比无统计学显著性差异（OR=1；95%CI：0~1）。 结论 研究人员应开展更为精准的研究，以进一步明确二者间的关联。此外，在此类患者的常规临床诊疗中纳入肠道蠕虫感染的定期筛查，具有重要的临床价值。