Tuberculosis (TB) is a pressing global human health problem that resulted in over 10 million cases and 1.3 million deaths in 2022.1 The WHO proposes to end this global epidemic by 2035, which would necessitate reducing TB deaths by 95%, TB incidence by 90%, and eliminating catastrophic costs for TB-affected households compared with the 2015 levels. There is doubt this can be achieved. An established means to attempt these reductions would be greater yet more targeted use of preventive antibiotic therapy for clinically asymptomatic (referred to as latent) early or limited infection. A recent systematic review estimated the overall effectiveness of preventive treatment (TPT) is 49%.2 The risk reduction conferred by TPT was found greater in high-burden (0.31) versus low-burden (0.58) settings. Most studies covered by the analysis deployed established TPT regimens of 6–9 months isoniazid (H), 4 months of rifampicin (R) or 3 months of combined RH therapy. Shorter or less intensive rifapentine (P) containing regimens of equivalent efficacy (1HP and 3HP) are now available.3 The review concluded the number needed to treat with TPT to prevent one case of ‘active’ TB was between 29 and 43 in high-burden settings and between 213 and 455 in low-burden settings. These numbers reflect the low overall risk of TB even following infectious contact (5–10% mainly over the first 2 years). In the review, those with a positive tuberculin-skin-test (TST) or IFN gamma release assay (IGRA) result at baseline benefitted from greater protection by TPT (≥80%), regardless of age. However, the specificity of these tests to predict progression is modest, and thus, their widespread use and implementation of TPT in high-burden settings is therefore low. The modest specificity of IGRA …

中文翻译：

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早期结核病的影像学检查


结核病 （TB） 是一个紧迫的全球人类健康问题，2022 年导致超过 1000 万例病例和 130 万人死亡。世界卫生组织提议到 2035 年结束这一全球流行病，与 2015 年的水平相比，这需要将结核病死亡人数减少 95%，结核病发病率降低 90%，并消除受结核病影响家庭的灾难性成本。这是否能实现值得怀疑。尝试减少这些感染的既定方法是更大、更有针对性地使用预防性抗生素治疗来治疗临床无症状（称为潜伏性）早期或局限性感染。最近的一项系统评价估计，预防性治疗 （TPT） 的总体有效性为 49%.2 TPT 赋予的风险降低在高负担 （0.31） 与低负担 （0.58） 环境中的降低更大。分析涵盖的大多数研究都采用了既定的 TPT 方案，即 6-9 个月的异烟肼 （H）、4 个月的利福平 （R） 或 3 个月的联合 RH 治疗。含有同等疗效（1HP和3HP）的更短或强度较低的利福喷丁（P）方案现已上市。该评价得出结论，在高负担环境中，需要用 TPT 治疗以预防一例“活动性”结核病的人数在 29 至 43 例之间，在低负担环境中在 213 至 455 例之间。这些数字反映了即使在感染性接触后患结核病的总体风险也很低（主要在前 2 年为 5-10%）。在本综述中，无论年龄大小，基线时结核菌素皮肤试验 （TST） 或 IFN γ 释放试验 （IGRA） 结果呈阳性的人都受益于 TPT 的更大保护 （≥80%）。然而，这些测试预测进展的特异性适中，因此，它们在高负担环境中广泛使用和实施 TPT 的情况较低。IGRA 的适度特异性......