在结核病治疗完成后对结核病后肺病进行查:症状是否足够?
Jamilah Meghji1, Vester Gunsaru2, Beatrice Chinoko2
1National Heart & Lung Institute, Imperial College London, London, United Kingdom.
PLOS global public health
|January 29, 2024
概括
肺结核 (TB) 幸存者经常经历长期的肺部疾病. 结核病治疗完成后的症状查有效地预测了结核病后的肺病 (PTLD),并可以指导护理,而螺旋计和成像几乎没有额外的益处.
科学领域:
- 肺部医学 肺部医学
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 肺结核 (TB) 幸存者面临着巨大的后结核肺病 (PTLD) 的负担.
- 需要有效的查策略来识别低资源环境中面临PTLD风险的个体.
- 目前用于PTLD的预测模型通常缺乏在现实世界程序设置中的验证.
研究的目的:
- 评估结核病治疗完成时测量的参数在预测后续发病率方面的表现.
- 在资源有限的环境中为PTLD查提供信息的程序方法.
- 确定肺结核幸存者的不良结果的关键预测因素.
主要方法:
- 来自马拉维城市布兰泰尔的队列数据的二次数据分析.
- 为五个发病结果开发回归模型 (逻辑,惩罚,弹性网).
- 包括人口,临床,症状,螺旋测量和胸部X射线变量作为预测因素.
- 使用ROC AUC评估模型性能,并确定正负预测值 (NPV).
主要成果:
- 结核病治疗完成后的呼吸道症状是患病率最强的预测因素.
- 喘息强烈预测螺旋测量下降,健康寻求,和持续的症状/功能限制.
- 活动限制预测了未来的症状/功能限制和财务影响.
- 螺旋测量和胸部X射线参数没有显著改善模型性能.
- 对于不良结果,ROC AUC值在0.65-0.77之间;活动限制具有高的NPV (78-98%).
结论:
- 预测后结核病发病率是具有挑战性的,但在治疗完成后的症状查是优先考虑后结核病护理的有希望的方法.
- 基于症状的查可以有效地识别患有PTLD风险的个人.
- 螺旋测量和胸部成像在这种情况下为预测PTLD提供了有限的附加值.
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