在结核病频谱中,重新评估结核菌感染后的进展和途径
Katherine C Horton1, Alexandra S Richards1, Jon C Emery1
1Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom.
概括
大多数人在10年内清除Mycobacterium结核病 (Mtb) 感染,但少数人进展为结核病 (TB). 了解各种疾病途径对于有效的结核病预防和治疗至关重要.
科学领域:
- 流行病学 流行病学
- 传染性疾病 传染性疾病
- 数学建模的数学建模
背景情况:
- 对于结核病 (TB) 从Mycobacterium tuberculosis (Mtb) 感染的进展的传统理解是有限的,因为它忽视了疾病的各种表现.
- 在Mtb感染后,存在各种疾病,包括最小,亚临床和临床结核病.
研究的目的:
- 开发和校准Mtb感染自然史的确定性模型,包括各种疾病状态.
- 估计结核病发病率,进展途径和Mtb感染后的10年结果.
主要方法:
- 对结核病自然史数据的系统审查为确定性模型提供了信息.
- 该模型的贝叶斯校准使用了有关结核素转换,结核病进展,疾病状态转变,持续时间和死亡率的历史队列数据.
- 模拟的队列结局被估计为发病率,途径和10年随访.
主要成果:
- 在10年内,92.0%的人自行清除了Mtb感染;7.9%的人发展为结核病.
- 在结核病患者中,68.6%患有传染病,33.2%发展为临床疾病.
- 进展到最小的疾病发生在早期 (2年内为98%),而亚临床和临床结核病的发展较晚 (71%和44%,分别在2年内).
- 模型校准需要多个进展途径,49.5%的感染性疾病患者在州之间波动.
结论:
- 在Mtb感染后存在不同的途径,需要明确的疾病状态值.
- 有效的结核病预防和治疗策略需要对Mtb感染和疾病进展的频谱有细微了解.
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