【作者】 刘二勇； 成诗明； 周林； 王雪静； 赖钰基； 王冬梅； 杨道威； 李涛； 王笑春； 马士文； 刘刚； 华建昭；

【Author】 Eryong Liu~1,Shiming Cheng~1,Zhou Lin~1,Wang Xuejing~1,Lai Yuji~1, Wang Dongmei~1,Yang Daowei~1,Li Tao~1,Wang Xiaochun~1,Ma Shiwen~2,Liu Gang~3,Hua Jianzhao~4 (1:National Center for TB Control and Prevention,China CDC,Beijing 102206;2.Henan Provincial CDC, Zhengzhou 450016;3.Sichuan Provincial CDC,Chengdu 610041,4.Yunnan Provincial CDC,Kunming 650022)

【机构】 中国疾病预防控制中心结核病预防控制中心； 河南省疾病预防控制中心； 四川省疾病预防控制中心； 云南省疾病预防控制中心；

【摘要】 目的 :探讨结核病筛查问卷在HIV/AIDS病人中确诊和排除活动性结核的作用,为基层医生HIV/AIDS中活动性结核的诊断提供参考。方法 :2006年9月至2007年2月,对4个县HIV/AIDS病人进行连续纳入,通过结核病筛查问卷收集了每个患者的结核病可疑症状信息,并对部分患者进行了进一步的临床检查。分析了单一症状,多个症状在活动性结核诊断上的敏感度、特异度、似然比、验后概率。分析采用的金标准是当地艾滋病诊断治疗专家组根据痰检、胸片等定诊结果。结果 :我国当前采用的HIV/AIDS病人结核病筛查问卷灵敏度为100%,特异度为65.6%。HIV/AIDS病人中可疑症状出现频次排序依次为:咳嗽咳痰、夜间盗汗、和容易疲劳。出现痰中带血、反复低烧的患者,患活动性结核的概率显著增加。单一症状分析,咳嗽咳痰在诊断活动性结核上灵敏度最高为92.1%,特异度为73.8%。咳嗽咳痰阴性是排除活动性结核的有力指标。可疑症状筛查阳性患者中,出现1-3个症状的可疑者占85.4%,发现了78.6%的确诊活动性结核。仅有1个症状可疑者,验后概率为5%,同时,拥有2-5个可疑症状的患者,验后概率均稳定在12%左右,应受到同等重视。结论 :结核病筛查问卷筛查成本低且有效。在资源有限,缺少诸如培养条件地区,简单可行的筛查问卷是发现活动性结核的有力工具。更多还原

【Abstract】 Objective:The purpose of this study is to determine the role of TB screening questionnaire in diagnosis and ruling out active TB in people living with HIV/AIDS,and provide reference for basic level doctors.Methods:HIV/AIDS patients were consecutively enrolled in 4 counties during Sep.2006 to Feb.2007.For each HIV/AIDS patient,TB suspicious symptoms were obtained through TB screening questionnaire,and part of patients received further clinical evaluation.Sensitivity,specificity,likelihood ratios,and post-test probability were analyzed for any single symptom,and combination of multiple symptoms.The gold standard is the diagnosis result by sputum smear,X ray,and clinical expert committee. Results:Current TB screening questionnaire adopted by China has 100%sensitivity and 65.6%specificity. The highest frequency of symptoms occurred in HIV/AIDS patients were:cough,night sweat,and fatigue. The probability of active TB increased significantly in patients with bloody sputum and those with recurrent fever.The single symptom of cough has the highest 92.1%sensitivity among all single symptoms, and its specificity is 73.8%.Cough negative is a strong indicator in ruling out active TB.85.4%of HIV/AIDS patients have 1 to 3 symptoms.Active TB detected among them contributes to 78.6%of all diagnosed TB cases.For HIV/AIDS with only 1 TB suspicious symptom,the post test probability of active TB is 5%;while for those with 2 to 5 symptoms,this probability is around 12%.Therefore patient with 2 to 5 symptoms are equally important.Conclusion:TB screening questionnaire constitute a low-cost and effective tool to increase detection of active TB in people living with HIV/AIDS,especially in resource-constraint setting,simple and feasible screening could facilitate the detection.更多还原