The use of the paediatric tuberculosis score chart in an HIV-endemic area
The use of the paediatric tuberculosis score chart in an HIV-endemic area
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DOI：
10.1046/j.1365-3156.2002.00882.x
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发表时间：
2002-05-01
影响因子：
3.3
通讯作者：
van Rheenen, P
中科院分区：
文献类型：
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作者：
van Rheenen, P
背景在人类免疫缺陷病毒(HIV)流行区诊断结核病是极其困难的，因为HIV血清阳性儿童的临床症状很容易与结核病混淆。儿科结核病记分表(TSC)是为资源贫乏的国家开发的，尽管这一评分系统尚未在艾滋病毒高发国家得到评估，但它的使用仍在继续推广。目的评估TSC在艾滋病毒流行地区的实用性。方法1999年1月至12月在赞比亚铜带省圣特里萨教会医院进行的前瞻性队列研究。将TSC(TB评分)的结果与诊断算法的结果进行比较，结合痰涂片镜检、结核杆菌培养和聚合酶链式反应、结核菌素皮肤试验、胸片和组织学结果。根据艾滋病毒血清学和临床结果，他们被分为四组：结核病儿童(23名艾滋病毒血清阳性；52名艾滋病毒血清阴性)，21名艾滋病毒感染儿童而不是结核病，51名艾滋病毒血清阴性儿童而不是结核病。两组之间的结核病评分差异并不显著。TSC诊断结核病的敏感度为88%，但特异度仅为25%。结论TSC不应作为HIV高发国家的诊断工具。这种评分系统的低特异性导致了对结核病的过度诊断和不必要的昂贵的抗结核药物的使用。迫切需要用于艾滋病毒流行地区儿童结核病诊断的新工具。
BACKGROUND Diagnosing tuberculosis (TB) in a human immunodeficiency virus (HIV)-endemic area is extremely difficult, as the clinical symptoms of HIV-seropositive children can be easily confounded with TB. The paediatric tuberculosis score chart (TSC) was developed for resource-poor countries and its use continues to be promoted despite the fact that this scoring system has not been evaluated in countries with a high HIV prevalence.OBJECTIVE To assess the utility of the TSC in an HIV-endemic area.METHOD A prospective cohort study conducted between January and December 1999 at St Theresa's Mission Hospital, Copperbelt Province, Zambia. Results of the TSC (TB score) were compared with the results of a diagnostic algorithm, incorporating sputum smear microscopy, culture and polymerase chain reaction of Mycobacterium tuberculosis , tuberculin skin test, chest X-ray and histology eventually.RESULTS A total of 147 children were enrolled in the study. On the basis of HIV-serology and clinical findings they were divided into four groups: children with TB (23 HIV-seropositive; 52 HIV-seronegative), 21 HIV-infected children without TB and 51 HIV-seronegative children without TB. The differences in TB scores between the groups were not significant. The sensitivity of the TSC to diagnose TB in this study was 88%; but the specificity was only 25%.CONCLUSION The TSC should not be used as a diagnostic tool in countries with a high HIV prevalence. The low specificity of this scoring system leads to overdiagnosis of TB and unnecessary use of costly, antituberculous drugs. New tools for TB diagnosis in children in HIV-endemic areas are urgently needed.