【摘要】 目的 探讨老年菌阴肺结核诊断评分系统在老年疑似肺结核患者中的临床应用价值及可行性。方法 采用老年菌阴肺结核临床诊断评分系统,对在2015年6月至2015年12月于广州市胸科医院结核内科及广州市番禺区、越秀区、海珠区结核病防治所诊治的老年疑似肺结核患者450例进行前瞻性研究。记录其病程、结核全身中毒症状、结核菌素纯蛋白衍生物(purified protein derivative,PPD)试验、血清抗结核抗体(against tuberculosis antigen,ATA)、影像学表现等资料,使用该评分系统进行评分,并追踪其临床最终诊断结果,采用SPSS 19.0软件进行统计学分析。计数资料、组间样本间“率”的比较采用χ~2检验,计量资料采用t检验,以P<0.05为差异有统计学意义;以符合率、正确率、敏感度、特异度、阳性预测值、阴性预测值描述评分系统的诊断效能。结果 476例老年疑似结核病患者最终经排除标准退组26例,共450例纳入分析。其中经诊断评分系统诊断肺结核304例,非结核性肺病146例;而最终临床诊断肺结核者323例(肺结核组),非结核性肺部疾病者127例(非肺结核组)。经诊断评分系统,肺结核患者较非肺结核患者在有结核全身中毒症状[54.80%(177/323)、9.45%(12/127)]、病程≥4～周[72.14%(233/323)、59.84%(76/127)]、PPD试验硬结平均直径≥5mm [66.25%(214/323)、43.31%(55/127)]、血清抗结核抗体阳性[84.83%(274/323)、44.09%(56/127)]、胸部CT提示结核病表现([89.47%(289/323)、6.30%(8/127)]各项得分差异均有统计学意义(χ~2=75.11,P<0.01;χ~2=7.42,P=0.024;χ~2=75.28,P<0.01;χ~2=23.77,P<0.01;χ~2=313.19,P<0.01);评分结果以得分10分为截断点,≥10分为肺结核,<10分为非肺结核患者,13～19分诊断符合率100.00%(200/200),10～12分诊断符合率85.58%(89/104),6～9分诊断符合率67.62%(71/105),<6分诊断符合率100.00%(41/41)。使用该评分系统诊断的正确率为89.11%(401/450),敏感度为89.47%(289/323),特异度为88.19%(112/127),阳性预测值为95.07%(289/304),阴性预测值为76.71%(112/146)。结论 该评分系统可作为老年疑似肺结核的临床诊断预测工具,可在临床肺结核诊断工作中推广及应用。更多还原

【Abstract】 Objective To explore the value and feasibility of a scoring system for foreseeing the diagnosis of smear-negative pulmonary tuberculosis(TB)in the elderly TB suspects. Methods A total of 450 elderly patients,who visited the Guangzhou Chest Hospital or the district TB dispensaries(Panyu,Yuexiu,and Haizhu districts)in Guangzhou from June 2015 to December 2015 and were suspected as TB,were recruited in this study.The following information were collected from each of the recruited patients and recorded,including the course of the disease,TB symptoms,tuberculin purified protein derivative(PPD)test results,serum anti-TB antibody(ATA)test results,imaging findings,etc.Those patients were evaluated by using this TB diagnostic scoring system and were given a foreseeing diagnosis as TB or non-TB,and then the clinical final diagnosis was tracked.SPSS 19.0 software was used for statistical analysis.χ~2 test was used to compare the rate between groups and t-test was used for analysis of measurement data.P<0.05 was considered to be statistically significant difference.The performance of the scoring system was assessed by its consistence rate,accuracy rate,sensitivity,specificity,positive predictive value and negative predictive value. Results A total of 476 patients were screened and 450 patients were considered to be TB suspects while 26 patients were excluded according to the exclusion criteria.The 450 patients were involved into the analysis.Out of them,304 patients were considered as TB and 146 patients were excluded from TB by using the diagnostic scoring system.The cut-off point of this scoring system was 10 points,those patients who scored 10 or above were regarded as TB while those patients who scored less than 10 points were regarded as non-TB.Finally,323 patients were clinically confirmed TB(TB group)and 127 patients were non-TB(non-TB group).The proportions of the patients who had the following variables were statistically significant higher in the TB group than those in the non-TB group:more TB symptoms(54.80%(177/323)vs.9.45%(12/127);χ~2=75.11,P<0.001),the course of disease was longer than 4 weeks(72.14%(233/323)vs.59.84%(76/127);χ~2=7.42,P=0.024),the diameter of induration of PPD ≥10 mm(66.25%(214/323)vs.43.31%(55/127);χ~2=75.28,P<0.001),positive serum anti-TB antibody(84.83%(274/323)vs.44.09%(56/127);χ~2=23.77,P<0.001),imaging findings indicated as TB(89.47%(289/323)vs.6.30%(8/127);χ~2=313.19,P<0.001).By using the diagnostic scoring system,the consistent rates of TB diagnosis were 100.00%(200/200),85.58%(89/104),67.62%(71/105)and 100.00%(41/41)respectively in the patients who were scored 13-19 points,10-12 points,6-9 points and<6 points.The accuracy rate,sensitivity,specificity,positive predictive value and negative predictive value of this scoring system were 89.11%(401/450),89.47%(289/323),88.19%(112/127),95.07%(289/304)and76.71%(112/146)respectively. Conclusion The scoring system can be used as a forecasting tool of the clinical TB diagnosis in the elderly TB suspects and can be expanded to practise.更多还原