Dolan J G, Bordley D R
Department of Medicine, Rochester General Hospital, NY 14621.
Med Decis Making. 1994 Jan-Mar;14(1):1-8. doi: 10.1177/0272989X9401400101.
To provide insight into the decision whether to use isoniazid prophylaxis in uncomplicated cases of positive tuberculin tests, the authors conducted a multicriteria decision analysis using the analytic hierarchy process. If reducing the chance of developing active tuberculosis is considered at least slightly more important than avoiding isoniazid-related side effects, isoniazid prophylaxis is the better strategy for all patients. If avoiding isoniazid-related side effects is considered at least slightly more important, no prophylaxis is the better strategy for all patients. If these two considerations are judged equally important, the better strategy depends on patient age, the anticipated effectiveness of isoniazid prophylaxis, and whether or not the patient is a recent tuberculin convertor. The tradeoff between avoiding active tuberculosis and avoiding isoniazid-related side effects is the most important factor in the decision regarding the proper management of patients with positive tuberculin tests. These results emphasize the importance of taking an individualized approach to the management of these patients.
为深入了解在结核菌素试验阳性的非复杂性病例中是否使用异烟肼预防治疗的决策，作者采用层次分析法进行了多标准决策分析。如果认为降低发生活动性结核病的几率比避免异烟肼相关副作用至少略为重要，那么异烟肼预防治疗对所有患者来说是更好的策略。如果认为避免异烟肼相关副作用至少略为重要，那么不进行预防治疗对所有患者来说是更好的策略。如果判断这两个考量同样重要，那么更好的策略取决于患者年龄、异烟肼预防治疗的预期效果以及患者是否为近期结核菌素试验阳转者。在避免活动性结核病和避免异烟肼相关副作用之间进行权衡是结核菌素试验阳性患者恰当管理决策中最重要的因素。这些结果强调了对这些患者采取个体化管理方法的重要性。
