不要伤害 - 在社区范围的结核病查中重新评估过度治疗的风险
Rein M G J Houben1,2, Lara D Veeken3, Alvaro Schwalb1,2,4
1TB Modelling Group, TB Centre, LSHTM, London, UK.
medRxiv : the preprint server for health sciences
|September 26, 2025
概括
扩大社区范围的结核病 (TB) 查,即使有潜在的过度治疗,也提供了比危害更大的好处. 使用像Xpert Ultra这样的分子测试来增加查覆盖率,可以避免更多的残疾调整寿命年 (DALYs),并改善患者的治疗结果.
科学领域:
- 公共卫生 公共卫生
- 传染病流行病学 传染病流行病学
- 诊断测试评价 诊断测试评价
背景情况:
- 为了消除结核病 (TB),社区范围内的查至关重要.
- 人们担心结核病错误阳性诊断导致的过度治疗.
- 目前对结核病测试性能的参考标准存在局限性.
研究的目的:
- 估计在不同流行值下,社区范围内的结核病查覆盖率.
- 为了评估Xpert Ultra的性能与各种参考标准相比.
- 量化来自过度治疗和治疗不足的潜在危害 (DALY).
主要方法:
- 估计结核病查覆盖率为0.5%,0.25%和0.1%的流行门.
- 评估Xpert Ultra测试的性能,使用唾液培养,临床评估和疾病进展作为参考标准.
- 用残疾调整寿命年 (DALYs) 来量化伤害,用于治疗和非治疗场景.
主要成果:
- 降低患病率值可以显著提高查覆盖率.
- 具体性和积极预测值 (PPV) 随着疾病进展作为参考标准而改善.
- 拒绝结核病治疗的危害远远高于不适当治疗的危害.
结论:
- 在阳性分子测试后结核病治疗的好处超过了在社区范围内的查中过度治疗的风险.
- 这些发现支持扩大简化社区范围的结核病查覆盖范围.
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