在评估结核病的细菌学负面个体中与结核病治疗开始相关的因素:个体患者数据的元分析
Sun Kim1, Melike Hazal Can1, Tefera B Agizew2
1Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
medRxiv : the preprint server for health sciences
|April 22, 2024
概括
临床医生经常根据症状开始结核病 (TB) 治疗,即使有负面的诊断测试. 像Xpert MTB/RIF这样的更先进的测试降低了这种可能性,表明了转向基于证据的治疗决定的趋势.
科学领域:
- 医学诊断 医学诊断 医学诊断
- 传染病流行病学 传染病流行病学
- 临床决策 - 临床决策
背景情况:
- 全球超过三分之一的肺结核 (TB) 诊断依赖于经过阴性测试结果后的临床判断.
- 了解影响治疗启动的因素,尽管负面诊断对于评估新诊断工具的影响至关重要.
- 这项研究解决了有关结核病诊断临床决策的关键知识差距.
研究的目的:
- 为了确定与开始结核病治疗的相关因素,在个体有负诊断测试结果.
- 分析不同诊断方法对治疗决策的影响.
主要方法:
- 系统性审查和个人患者数据元分析 (2010年1月 - 2022年12月).
- 包括试验和队列研究,在常规环境中评估个人对结核病的评估.
- 层次贝叶斯逻辑回归用于识别在负细菌学测试后与治疗启动相关的因素.
主要成果:
- 男性性别,先前的结核病史,咳,夜间出汗和艾滋病毒感染 (非ART) 与治疗开始的增加有关.
- 与涂抹显微镜相比,Xpert MTB/RIF治疗开始的可能性较小.
- 最近几年,在阴性测试后开始治疗的情况有所下降.
结论:
- 临床和人口因素显著影响决定启动结核病治疗,尽管测试结果是负面的.
- 采用更敏感的,基于PCR的诊断方法,如Xpert MTB/RIF,在没有阳性测试的情况下,治疗开始的可能性降低.
- 这些发现凸显了结核病诊断和治疗启动实践的不断变化的格局.
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