在评估结核病的细菌学负面个体中与结核病治疗启动相关的因素:单个患者数据的元分析
Sun Kim1, Melike Hazal Can1, Tefera B Agizew2
1Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
PLoS medicine
|January 13, 2025
概括
临床医生根据患者的症状和病史开始结核病 (TB) 治疗,即使有负面的细菌学测试. 当使用Xpert MTB/RIF等先进诊断时,治疗决策的可能性较小.
科学领域:
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
- 临床医学 临床医学
背景情况:
- 超过三分之一的肺结核诊断依赖于在阴性细菌学测试后的临床判断.
- 关于影响结核病 (TB) 治疗决策的因素的数据有限,初始测试结果为负.
研究的目的:
- 为了确定与启动结核病治疗相关的因素,当初始细菌学测试是负的.
- 分析结核病治疗启动决策的趋势.
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).
- 包括在日常环境中对结核病进行评估的个体的试验和队列研究.
- 阶层贝叶斯逻辑回归用于识别影响因素.
主要成果:
- 男性的性别,先前的结核病史,咳,夜间出汗和艾滋病毒感染 (非ART) 与治疗开始的可能性更高有关.
- 与唾液涂抹显微镜相比,Xpert MTB/RIF治疗开始的可能性较小.
- 近年来,开始治疗的可能性有所下降.
结论:
- 临床因素显著影响结核病治疗决策,尽管有负面的细菌学结果.
- 采用像Xpert MTB/RIF这样更敏感的诊断方法与在没有阳性测试结果的情况下减少治疗开始相关.
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