Identifying pulmonary tuberculosis in patients with negative sputum smear results
Identifying pulmonary tuberculosis in patients with negative sputum smear results
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DOI：
10.1378/chest.120.2.349
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发表时间：
2001-08-01
期刊：
影响因子：
9.6
通讯作者：
Chambers, HF
中科院分区：
文献类型：
--
作者：
Kanaya, AM;Glidden, DV;Chambers, HF
背景资料：临床医生需要决定是否开始经验性治疗的病人谁是怀疑有结核病（TB），但有阴性痰涂片结果。培养结果可能需要数周时间，延迟治疗可能会导致疾病的进一步传播。研究目的：确定痰涂片阴性患者的临床、人口统计学和影像学特征，并建立结核病预测规则。设计：回顾性图表回顾。设置：1993年至1998年，加利福尼亚州旧金山弗朗西斯科的大学附属公立医院。患者：47例结核病患者和141例因疑似肺结核而住院的对照组患者，痰涂片结果均为阴性。在多变量分析中，结核菌素皮肤试验结果阳性（比值比[OR]，4.8; 95%可信区间[CI]，2.0 - 11.9）与结核菌培养阳性的风险增加独立相关。非典型肺结核的影像学表现（OR，0.3; 95%CI，0.1 ~ 0.7）和咳痰伴咳嗽（OR，0.3; 95%CI，0.1 ~ 0.6）可预测风险降低。HIV血清阳性和胸片上纵隔淋巴结病之间的相互作用也与阳性TB培养结果相关（OR，7.2; 95%CI，1.4 - 36.0）。结核病预测评分（TPS）创建广泛的似然比，可能会影响后验概率结核病的30倍。结论：TPS投入的背景下，结核病的整体患病率在一个给定的区域，可以帮助临床医生决定，如果一个病人的痰涂片阴性结果应该开始经验性抗结核治疗或等待文化的结果。这些结果需要前瞻性验证。
Background: Clinicians need to decide whether to begin empiric therapy for patients who are suspected of having tuberculosis (TB) but have negative sputum smear results. Culture results may take weeks, and delaying treatment may allow further transmission of disease.Study objective; To identify the clinical, demographic, and radiographic characteristics that identify smear-negative patients who have TB, and to create a TB prediction rule.Design: Retrospective chart review.Setting: University-affiliated public hospital in San Francisco, CA, between 1993 and 1998. Patients: Forty-seven patients with TB and 141 control patients who were hospitalized with a suspicion of pulmonary TB; all had negative sputum smear results.Measurements and results: Demographic, clinical, and radiographic variables were determined by chart review. In multivariate analysis, a positive tuberculin skin test result (odds ratio [OR], 4.8; 95% confidence interval [CI], 2.0 to 11.9) was independently associated with an increased risk of a positive TB culture finding. A radiographic pattern not typical of pulmonary tuberculosis (OR, 0.3; 95% CI, 0.1 to 0.7) and expectoration with cough (OR, 0.3; 95% CI, 0.1 to 0.6) were predictive of a decreased risk. An interaction between HIV seropositivity and mediastinal lymphadenopathy on the chest radiograph was also associated with a positive TB culture result (OR, 7.2; 95% CI, 1.4 to 36.0). The TB prediction score (TPS) was created with widely ranging likelihood ratios that could affect the posterior probability of TB by 30-fold.Conclusion: The TPS put into context with the overall prevalence of TB in a given area may help clinicians decide if a patient with negative sputum smear results should start empiric antituberculous therapy or wait for culture results. These results need prospective validation.