加拿大麦吉尔大学Dick Menzies研究团队最近分析了结核菌素皮肤试验阳性或干扰素-γ释放试验阳性人群患结核病的风险。该项研究成果发表在2020年3月10日出版的《英国医学杂志》上。

为了确定初治的结核菌素皮肤试验（TST）阳性或干扰素-γ释放试验（IGRA）阳性或两者兼有的结核病的年增长率，这些特征常被认为会增加患结核病的风险，研究组对1990年1月1日至2019年5月17日Embase等大型数据库中结核病抗原阳性（TST和/或IGRA）的研究进行了一项系统回顾和荟萃分析。

最终共纳入122项研究。在三项一般人群研究中，33811名参与者中TST硬结≥10mm的结核病发生率为每1000人年0.3。在19个高危人群中，潜伏性肺结核感染的116197例阳性检测结果中，发病率始终高于普通人群。

在所有类型的结核病接触者中，IGRA结果阳性参与者的结核病发生率为每1000人年17.0，TST硬结≥5 mm阳性结果参与者的结核病发生率为每1000人年8.4。在HIV感染者中，IGRA结果阳性参与者的结核病发生率为每1000人年16.9，TST硬结≥5mm阳性结果的参与者为27.1。

移民、矽肺病或需要透析的人、移植??受者和囚犯的发病率也很高。在所有检测中，几乎所有风险组的检测阳性与检测阴性参与者之间的患病比率均显著高于1.0。

总之，TST或IGRA结果呈阳性的高危人群，结核病发生率很高。该研究结果有助于指导临床决策，以检测和治疗潜伏性结核感染。

附：英文原文

Title: Absolute risk of tuberculosis among untreated populations with a positive tuberculin skin test or interferon-gamma release assay result: systematic review and meta-analysis

Author: Jonathon R Campbell, Nicholas Winters, Dick Menzies

Issue&Volume: 2020/03/10

Abstract: AbstractObjective To determine the annual rate of tuberculosis development after a positive tuberculin skin test (TST) or interferon-gamma release assay result (IGRA), or both, among untreated populations with characteristics believed to increase the risk of tuberculosis (at risk populations).Design Systematic review and meta-analysis.Data sources Embase, Medline, and Cochrane Controlled Register of Trials from 1 January 1990 to 17 May 2019, for studies in humans published in English or French. Reference lists were reviewed.Eligibility criteria and data analysis Retrospective or prospective cohorts and randomised trials that included at least 10 untreated participants who tested positive to tuberculosis antigens (contained in TST or IGRA, or both) followed for at least 12 months. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and meta-analyses of observational studies in epidemiology (MOOSE) guidelines, two reviewers independently extracted study data and assessed quality using a modified quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Data were pooled using random effects generalised linear mixed models.Main outcome measures The primary outcome was tuberculosis incidence per 1000 person years among untreated participants who tested positive (TST or IGRA, or both) in different at risk subgroups. Secondary outcomes were the cumulative incidence of tuberculosis and incidence rate ratios among participants with a positive test result for latent tuberculosis infection compared with those with a negative test result in at risk subgroups.Results 122 of 5166 identified studies were included. In three general population studies, the incidence of tuberculosis among 33811 participants with a TST induration of ≥10 mm was 0.3 (95% confidence interval 0.1 to 1.1) per 1000 person years. Among 116197 positive test results for latent tuberculosis infection in 19 different at risk populations, incidence rates were consistently higher than those in the general population. Among all types of tuberculosis contacts, the incidence of tuberculosis was 17.0 (95% confidence interval 12.9 to 22.4) per 1000 person years for participants with a positive IGRA result and 8.4 (5.6 to 12.6) per 1000 person years for participants with a positive TST result of ≥5 mm. Among people living with HIV, the incidence of tuberculosis was 16.9 (10.5 to 27.3) for participants with a positive IGRA result and 27.1 (15.0 to 49.0) for participants with a positive TST result of ≥5 mm. Rates were also high for immigrants, people with silicosis or requiring dialysis, transplant recipients, and prisoners. Incidence rate ratios among test positive versus test negative participants were significantly greater than 1.0 in almost all risk groups, for all tests.Conclusions The incidence of tuberculosis is substantial in numerous at risk populations after a positive TST or IGRA result. The information from this review should help inform clinical decisions to test and treat for latent tuberculosis infection.

DOI: 10.1136/bmj.m549

Source: https://www.bmj.com/content/368/bmj.m549