成年人潜伏性结核感染的查:美国预防服务工作组的最新证据报告和系统审查
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
概括
潜伏性结核感染 (LTBI) 的查测试显示中度敏感性和高特异性. 治疗有效地减少了活跃结核病的进展,但异化物增加了肝毒性风险.
科学领域:
- 公共卫生
- 传染性疾病
- 预防医学
背景情况:
- 潜伏性结核感染 (LTBI) 可以发展为活跃性结核病 (TB),导致显著的发病率和死亡率.
- 有效的查和治疗策略对于预防和控制结核病至关重要.
研究的目的:
- 审查成人LTBI查和治疗的益处和危害的证据.
- 根据美国预防服务工作组 (USPSTF) 的指导方针.
主要方法:
- 关于LTBI查和治疗的英语研究的系统审查.
- 包括PubMed/MEDLINE,Cochrane图书馆和试验登记册的数据,截至2023年1月.
- 分析了结核素皮肤测试 (TST) 和干扰素释测试 (IGRA) 的准确性;综合了随机临床试验和元分析的结果.
主要成果:
- 没有研究直接比较LTBI查与没有查.
- 对于LTBI检测,TST和IGRA的敏感度中等,特异性高.
- 长期结核病治疗方案显著降低了结核病进展的风险 (异化的RR为0. 35).
- 异化物治疗与肝毒性风险增加有关 (RR,4. 59).
结论:
- 虽然LTBI的查测试是准确的,但与没有查相比,它们的益处和危害缺乏直接证据.
- 通过推的治疗方案治疗LTBI是有效的预防活动性结核病.
- 肝毒性是与异化物治疗相关的显著危害,需要仔细监测.
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