估计低收入和中等收入国家结核病错误诊断的数量
Ana van Lieshout Titan1,2, Peter J Dodd3, Ted Cohen4
1Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Nature medicine
|January 7, 2026
概括
结核病诊断错误很常见,数百万人被错误诊断,许多结核病患者被错过. 新的测试可以提高准确性,但需要更高的灵敏度和更少的依赖临床判断,以有效控制结核病.
科学领域:
- 全球健康 全球健康
- 传染性疾病 传染性疾病
- 诊断的准确性 诊断的准确性
背景情况:
- 结核病 (TB) 仍然是全球传染病死亡的主要原因.
- 有效的结核病控制取决于准确和及时的诊断,特别是在高负担的国家.
- 目前的诊断策略面临着有效识别活跃结核病例的挑战.
研究的目的:
- 评估全球结核病例发现策略的表现.
- 量化结核病检测中的误诊 (错误阳性和错误阴性) 的程度.
- 评估新诊断技术对结核病诊断准确性的潜在影响.
主要方法:
- 世界卫生组织对111个低收入和中等收入国家的2023年结核病诊断数据的分析.
- 根据报告的通知和假设的疾病患病率,估计正确和不正确诊断的结核病例.
- 建模基于聚合酶连锁反应 (PCR) 的诊断与当前方法的影响.
主要成果:
- 据估计,在2023年,约有205万人接受了错误的阳性结核病诊断,100万人接受了错误的阴性诊断.
- 最多30%的结核病通知可能代表没有活跃结核病的个人.
- 扩大PCR诊断可以减少诊断不足,但对错误阳性结果的改善有限.
结论:
- 当前全球结核病诊断存在重大不准确性,导致过度和不足诊断.
- 改善结核病诊断需要在诊断敏感性方面取得进展,可能通过细菌学测试.
- 减少对临床诊断的依赖对于提高结核病例检测的整体准确性至关重要.
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