背景:结核病(TB)是包括亚洲在内的全世界严重的公共卫生问题。亚洲国家的结核病负担很高,大量人口携带潜伏性结核病感染(LTBI)。
目的:本系统综述和荟萃分析旨在评估亚洲国家的LTBI患病率。
方法:我们在PubMed上进行了系统的文献检索,Embase,和ScienceDirect确定2005年1月1日至2023年1月1日发表的相关文章,调查了亚洲人群中潜伏性结核病的总体患病率。在2011年至2016年和2017年至2023年的研究期间,对亚洲亚区域进行了亚组分析,用于结核菌素皮肤试验(TST)和干扰素γ释放测定(IGRA),分别,以及Quantiferon-TB(QFT)和TSPOTTB测试。使用DerSimonian和Laird的随机效应模型来汇总使用TST和IGRA发现的LTBI的患病率。
结果:从标准电子数据库进行系统检索后,共纳入了15项研究。分析显示,根据IGRAs和TSTs(截止10毫米)的结果,亚洲潜伏性结核病的患病率为21%(95%置信区间[CI]:19%-23%)和36%(95%CI:12%-59%)。分别。基于IGRA,2011年至2016年,潜伏性结核病的患病率为20%(95%CI:13%-25%),2017年至2023年为21%(95%CI:18%-24%).使用QFT,患病率为19%(95%CI:17%-22%),使用TSPOT,患病率为26%(95%CI:21%-31%).根据联合国亚洲分部,使用TST的南部地区患病率较高,西部地区患病率最低,使用IGRA检验的东南部地区患病率较高,西部地区患病率最低.
结论:几乎四分之一的亚洲人口患有LTBI。由于在某些领域无法使用标准测试,其诊断通常会带来诊断挑战。鉴于这种流行,建议采用具有现有标准检测的大规模筛查计划,对于检测呈阳性的个体,应考虑公众意识以及抗结核方案.然而,为了有效实施,我们需要承担起负担能力,可用性,并考虑到此类干预措施的成本效益。
Tuberculosis (TB) is a serious public health concern around the world including Asia. TB burden is high in Asian countries and significant population harbor latent tuberculosis infection(LTBI).
This systematic review and meta-analysis aims to evaluate the prevalence of LTBI in Asian countries.
We performed a systematic literature search on PubMed, Embase, and ScienceDirect to identify relevant articles published between January 1, 2005, and January 1, 2023 investigating the overall prevalence of latent TB among people of Asia. Subgroup analysis was done for Asian subregions during the study period of 2011 to 2016 and 2017 to 2023, for tuberculin skin test (
TST) and interferon gamma release assay (IGRA), respectively, as well as for QuantiFERON-TB (QFT) and TSPOT TB tests. Der Simonian and Laird\'s random-effects model was used to pool the prevalence of LTBI found using
TST and IGRA.
A total of 15 studies were included after a systematic search from standard electronic databases. The analysis showed that the prevalence of latent TB in Asia was 21% (95% confidence interval [CI]: 19%-23%) and 36% (95% CI: 12%-59%) according to IGRAs and TSTs (cut off 10 mm) results, respectively. Based on IGRA, the prevalence of latent TB was 20% (95% CI: 13%-25%) in 2011 to 2016 and 21% (95% CI: 18%-24%) in 2017 to 2023. Using QFT, the prevalence was 19% (95% CI: 17%-22%) and using TSPOT, the prevalence was 26% (95% CI: 21%-31%). According to the United Nations division of Asia, the prevalence was higher for the Southern region and least for the Western region using
TST and higher in the South-Eastern region and least in the Western region using the IGRA test.
Almost a quarter of the Asian population has LTBI. Its diagnosis often poses a diagnostic challenge due to the unavailability of standard test in certain areas. Given this prevalence, a mass screening program is suggested with the available standard test and public awareness along with anti-TB regimen should be considered for individuals who test positive. However, for it to be implemented effectively, we need to take the affordability, availability, and cost-effectiveness of such interventions into account.