Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis.
Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis.
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DOI：
10.1186/s12916-018-1053-3
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发表时间：
2018-05-21
期刊：
影响因子：
9.3
通讯作者：
REMoxTB Consortium
中科院分区：
文献类型：
--
作者：
Murthy SE;Chatterjee F;Crook A;Dawson R;Mendel C;Murphy ME;Murray SR;Nunn AJ;Phillips PPJ;Singh KP;McHugh TD;Gillespie SH;REMoxTB Consortium
胸片用于结核病的诊断和严重程度评估。通过涂片分级和空化作为二元指标确定的疾病程度可以预测2个月的涂片结果，但很少有人确定放射学严重程度是否反映了诊断时的细菌负荷。来自1837名登记到REMoxTB试验中的具有涂片阳性肺TB的参与者的治疗前胸部X射线（吉莱斯皮等人，N Engl J Med 371：1577-87，2014）进行回顾性分析。使用Ralph评分系统对临床细节设盲的两名临床医生进行单独读数。一位独立的阅片人审查了质量评估和腔体存在的不一致结果。将空化存在与痰液培养物（MGIT 960）的阳性时间（TTP）作图。进行Wilcoxon秩和检验，以计算这些组的平均TTP差异。通过线性回归将受影响的平均肺野与log 10 TTP进行比较。在针对放射学严重程度的单变量回归分析中添加疾病严重程度和患者特征的基线标志物，并创建多变量回归模型以探索其关系。对于1354名参与者，中位TTP为117小时（4.88天），与有气穴的患者相比，无气穴的患者长26小时（95%CI 16-30，p < 0.001）。肺野受累百分比中位数为18.1%（IQR 11.3-28.8%）。TTP每增加10倍，受累肺野面积减少11.4%。多变量模型显示，血清白蛋白显着下降，肺野面积的百分比增加，在有和无空洞。此外，BMI和记录的TTP在具有空化的那些中具有小但显著的影响，并且在非空化组中严重TB症状的数量也具有小的影响，而在单变量分析中发现显著的其他因素在模型中失去了这种影响。在涂阳肺结核患者中，治疗前胸部X线的疾病放射学严重程度与细菌负荷弱相关。当与诊断时的其他变量相比时，这种效果在没有空化的情况下消失。在涂阳肺结核患者中，放射学严重程度确实反映了整体疾病的严重程度，但我们建议临床医生在过度解释诊断时放射学疾病程度的意义时应谨慎。本文的在线版本（10.1186/s12916-018-1053-3）包含补充材料，可供授权用户使用。
Chest radiographs are used for diagnosis and severity assessment in tuberculosis (TB). The extent of disease as determined by smear grade and cavitation as a binary measure can predict 2-month smear results, but little has been done to determine whether radiological severity reflects the bacterial burden at diagnosis. Pre-treatment chest x-rays from 1837 participants with smear-positive pulmonary TB enrolled into the REMoxTB trial (Gillespie et al., N Engl J Med 371:1577–87, 2014) were retrospectively reviewed. Two clinicians blinded to clinical details using the Ralph scoring system performed separate readings. An independent reader reviewed discrepant results for quality assessment and cavity presence. Cavitation presence was plotted against time to positivity (TTP) of sputum liquid cultures (MGIT 960). The Wilcoxon rank sum test was performed to calculate the difference in average TTP for these groups. The average lung field affected was compared to log 10 TTP by linear regression. Baseline markers of disease severity and patient characteristics were added in univariable regression analysis against radiological severity and a multivariable regression model was created to explore their relationship. For 1354 participants, the median TTP was 117 h (4.88 days), being 26 h longer (95% CI 16–30, p < 0.001) in patients without cavitation compared to those with cavitation. The median percentage of lung-field affected was 18.1% (IQR 11.3–28.8%). For every 10-fold increase in TTP, the area of lung field affected decreased by 11.4%. Multivariable models showed that serum albumin decreased significantly as the percentage of lung field area increased in both those with and without cavitation. In addition, BMI and logged TTP had a small but significant effect in those with cavitation and the number of severe TB symptoms in the non-cavitation group also had a small effect, whilst other factors found to be significant on univariable analysis lost this effect in the model. The radiological severity of disease on chest x-ray prior to treatment in smear positive pulmonary TB patients is weakly associated with the bacterial burden. When compared against other variables at diagnosis, this effect is lost in those without cavitation. Radiological severity does reflect the overall disease severity in smear positive pulmonary TB, but we suggest that clinicians should be cautious in over-interpreting the significance of radiological disease extent at diagnosis. The online version of this article (10.1186/s12916-018-1053-3) contains supplementary material, which is available to authorized users.
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影响因子：
2.1
作者：
Matsuoka, S;Uchiyama, K;Yamagishi, F
通讯作者：
Yamagishi, F
影响因子：
56.3
作者：
Dooley, Kelly E.;Chaisson, Richard E.
通讯作者：
Chaisson, Richard E.
影响因子：
3.7
作者：
Kenangalem E;Waramori G;Pontororing GJ;Sandjaja;Tjitra E;Maguire G;Kelly PM;Anstey NM;Ralph AP
通讯作者：
Ralph AP
影响因子：
3.7
作者：
Brust, James C. M.;Berman, Andrew R.;Gandhi, Neel R.
通讯作者：
Gandhi, Neel R.
DOI：
10.5588/ijtld.15.0690
发表时间：
2016-04-01
影响因子：
4
作者：
Kim, S.;Kim, H.;Han, S-S.
通讯作者：
Han, S-S.