OBJECTIVE 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 33 811 participants with a TST induration of ≥10 mm was 0.3 (95% confidence interval 0.1 to 1.1) per 1000 person years. Among 116 197 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. STUDY REGISTRATION PROSPERO CRD42019136608.

中文翻译：

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结核菌素皮肤试验阳性或干扰素-γ释放试验结果阳性的未治疗人群中结核病的绝对风险：系统评价和荟萃分析。

目的确定未经治疗的结核菌素皮肤试验（TST）阳性或干扰素-γ释放试验结果（IGRA）阳性或两者兼有的结核病的年增长率，这些特征被认为会增加患结核病的风险（处于危险的人群）。设计系统评价和荟萃分析。数据来源1990年1月1日至2019年5月17日，Embase，Medline和Cochrane控制的试验注册簿，用于以英语或法语发表的人类研究。参考清单进行了审查。资格标准和数据分析回顾性或前瞻性队列研究和随机试验，包括至少10名未经治疗的受试者，其结核杆菌抗原（TST或IGRA或两者均含）测试呈阳性，至少随访了12个月。根据流行病学指南中系统评价和荟萃分析（PRISMA）以及观察性研究的荟萃分析（MOOSE）指南的首选报告项目，两名审稿人使用诊断准确性研究的改良质量评估（QUADAS- 2）工具。使用随机效应广义线性混合模型合并数据。主要观察指标主要结果是不同危险亚组的试验阳性（TST或IGRA，或两者均呈阳性）的未经治疗的参与者每千人年的结核病发生率。次要结果是潜伏性结核感染检测结果为阳性的参与者与高危亚组检测结果为阴性的参与者的结核累积发病率和发生率之比。结果包括5166项确定的研究中的122项。在三项总体人群研究中，TST硬结≥10 mm的33 811名参与者中，每1000人年的结核病发生率为0.3（95％置信区间0.1到1.1）。在19个不同的高风险人群的116 197次潜伏性结核感染阳性测试结果中，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结果阳性的参与者的结核病发生率为每千人年17.0（95％置信区间12.9至22.4），TST阳性的参与者的结核病发生率为每1000人年8.4（5.6至12.6） ≥5 mm的结果。在IGRA结果呈阳性的参与者中，艾滋病毒携带者中，结核病的发生率为16.9（10.5至27.3），有27人。TST结果≥5mm的参与者为1（15.0至49.0）。移民，矽肺或需要透析的人，移植​​受者和囚犯的发病率也很高。在所有测试中，几乎所有风险组的测试阳性与测试阴性参与者之间的发生率比均显着高于1.0。结论在TST或IGRA结果阳性后，在许多高危人群中结核病的发生率很高。该评价的信息应有助于指导临床决策，以测试和治疗潜伏性结核感染。研究注册PROSPERO CRD42019136608。在所有测试中，几乎所有风险组的测试阳性与测试阴性参与者之间的发生率比均显着高于1.0。结论在TST或IGRA结果阳性后，在许多高危人群中结核病的发生率很高。该评价的信息应有助于指导临床决策，以测试和治疗潜伏性结核感染。研究注册PROSPERO CRD42019136608。在所有测试中，几乎所有风险组的测试阳性与测试阴性参与者之间的发生率比均显着高于1.0。结论在TST或IGRA结果阳性后，在许多高危人群中结核病的发生率很高。该评价的信息应有助于指导临床决策，以测试和治疗潜伏性结核感染。研究注册PROSPERO CRD42019136608。