大人の潜伏性結核感染症のスクリーニング:米国予防サービスタスクフォースの最新証拠報告と体系的レビュー
Daniel E Jonas1,2, Sean R Riley1,2, Lindsey C Lee2
1RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park.
JAMA
|May 2, 2023
まとめ
潜伏性結核感染症 (LTBI) のスクリーニングテストは,中程度の感度と高い特異性を示します. 治療は有効な結核の進行を減少させるが,イソニアジドは肝毒性のリスクを増加させる.
科学分野:
- 公衆衛生
- 感染症
- 予防 医療
背景:
- 潜伏性結核感染 (LTBI) は,活発な結核 (TB) に進行し,著しい罹病率と死亡率をもたらします.
- 効果的なスクリーニングと治療戦略は 結核の予防と制御に不可欠です
研究 の 目的:
- 大人のLTBIのスクリーニングと治療の利益と害に関する証拠をレビューする.
- 予防サービスタスクフォース (USPSTF) のガイドラインを参考にすること.
主な方法:
- LTBIのスクリーニングと治療に関する英語の研究の体系的なレビュー.
- 2023年1月までのPubMed/MEDLINE,Cochrane Library,および試験レジストリからのデータが含まれています.
- 結核素皮膚検査 (TST) とインターフェロン・ガンマ放出検査 (IGRA) の精度分析;ランダム化臨床試験とメタ分析から得られた合成結果.
主要な成果:
- LTBIのスクリーニングとスクリーニングを直接比較した研究はありませんでした.
- TSTとIGRAは,LTBIの検出に適度な感度と高い特異性を示した.
- LTBIの治療法は,活性結核への進行リスクを有意に低下させた (イソニアジドのRRは0. 35).
- イソニアジド治療は肝毒性のリスク増加と関連していた (RR,4. 59).
結論:
- LTBIのスクリーニングテストは正確ですが,スクリーニングなしと比較してその利点と害に関する直接的な証拠は不足しています.
- 推奨される治療法でLTBIの治療は,活性結核の予防に有効です.
- 肝毒性はイソニアジド治療に伴う重大な害であり,注意深いモニタリングが必要である.
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