■尽管结核病在低收入和中等收入国家非常普遍,使用当前的诊断方法仍有数百万例未被发现。为了解决这个问题,研究人员提出了预测规则。
■我们分析了诊断肺结核的现有预测规则,并确定了与该疾病具有中等至高强度关联的因素。
■我们对相关数据库进行了全面搜索(MEDLINE/PubMed,科克伦图书馆,科学直接,全球健康报告,和谷歌学者)截至2022年11月14日。包括开发低收入和中等收入国家成人肺结核诊断算法的研究。两名评审员进行了研究筛选,数据提取,和质量评估。使用诊断准确性研究质量评估-2评估研究质量。我们进行了叙事综合。
■在所选的26篇文章中,只有一半包括人类免疫缺陷病毒阳性患者。在有症状的人类免疫缺陷病毒患者中,影像学检查结果和体重指数是肺结核的有力预测因子,赔率比>4。然而,在人类免疫缺陷病毒阴性个体中,生物标志物显示与该疾病中度相关.在有症状的人类免疫缺陷病毒患者中,C-反应蛋白水平-10mg/L的敏感性和特异性为93%和40%,分别,而一项抗生素试验的特异性为86%,敏感性为43%.在涂片阴性的患者中,抗结核治疗的敏感性为52%,特异性为63%.
■预测因子和诊断算法的性能因患者亚组而异,例如在人类免疫缺陷病毒阳性患者中,射线照相结果,和体重指数是肺结核的有力预测因子。然而,在人类免疫缺陷病毒阴性个体中,生物标志物显示与该疾病中度相关.一些模型已经达到了世界卫生组织的建议。因此,未来应该做更多的工作来加强结核病筛查的预测模型,应该严格开发,考虑到临床工作中人群的异质性。
UNASSIGNED: Although tuberculosis is highly prevalent in low- and middle-income countries, millions of cases remain undetected using current diagnostic methods. To address this problem, researchers have proposed prediction rules.
UNASSIGNED: We analyzed existing prediction rules for the diagnosis of pulmonary tuberculosis and identified factors with a moderate to high strength of association with the disease.
UNASSIGNED: We conducted a comprehensive search of relevant databases (MEDLINE/PubMed, Cochrane Library, Science Direct, Global Health for Reports, and Google Scholar) up to 14 November 2022. Studies that developed diagnostic algorithms for pulmonary tuberculosis in adults from low and middle-income countries were included. Two reviewers performed study screening, data extraction, and quality assessment. The study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. We performed a narrative synthesis.
UNASSIGNED: Of the 26 articles selected, only half included human immune deficiency virus-positive patients. In symptomatic human immune deficiency virus patients, radiographic findings and body mass index were strong predictors of pulmonary tuberculosis, with an odds ratio of >4. However, in human immune deficiency virus-negative individuals, the biomarkers showed a moderate association with the disease. In symptomatic human immune deficiency virus patients, a C-reactive protein level ⩾10 mg/L had a sensitivity and specificity of 93% and 40%, respectively, whereas a trial of antibiotics had a specificity of 86% and a sensitivity of 43%. In smear-negative patients, anti-tuberculosis treatment showed a sensitivity of 52% and a specificity of 63%.
UNASSIGNED: The performance of predictors and diagnostic algorithms differs among patient subgroups, such as in human immune deficiency virus-positive patients, radiographic findings, and body mass index were strong predictors of pulmonary tuberculosis. However, in human immune deficiency virus-negative individuals, the biomarkers showed a moderate association with the disease. A few models have reached the World Health Organization\'s recommendation. Therefore, more work should be done to strengthen the predictive models for tuberculosis screening in the future, and they should be developed rigorously, considering the heterogeneity of the population in clinical work.