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中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (9): 937-941.doi: 10.3969/j.issn.1000-6621.2020.09.010

• 论著 • 上一篇    下一篇

结核病症状筛查在四川省布拖县HIV感染/AIDS患者中发现结核病患者的价值

李运葵, 何金戈(), 苏茜, 李婷, 李京, 高文凤, 杨文(), 毛光玉   

  1. 610041 成都,四川省疾病预防控制中心结核病预防控制所(李运葵、何金戈、苏茜、李婷、李京、高文凤、杨文);四川省凉山州疾病预防控制中心结核病预防控制所(毛光玉)
  • 收稿日期:2020-06-05 出版日期:2020-09-10 发布日期:2020-09-18
  • 通信作者: 何金戈,杨文 E-mail:hejinge@163.com;yangwenn@yeah.net
  • 基金资助:
    “十三五”国家科技重大专项(2018ZX10715003-002)

Value of tuberculin test in screening tuberculosis infection in HIV infected/AIDS patients in Butuo County, Sichuan Province

LI Yun-kui, HE Jin-ge(), SU Qian, LI Ting, LI Jing, GAO Wen-feng, YANG Wen(), MAO Guang-yu   

  1. Tuberculosis Prevention and Control Department, Sichuan Center for Disease Control and Prevention, Chengdu 610041, China
  • Received:2020-06-05 Online:2020-09-10 Published:2020-09-18
  • Contact: HE Jin-ge,YANG Wen E-mail:hejinge@163.com;yangwenn@yeah.net

摘要:

目的 探讨结核病症状筛查在HIV感染/AIDS患者中诊断活动性结核病的作用,为基层医生在HIV感染/AIDS患者中诊断结核病提供参考。方法 选取四川省凉山彝族自治州布拖县“两乡一镇”现场,对688例HIV感染/AIDS患者采用多项筛查的方法进行结核病筛查,其中“结核病症状筛查”共计发出了688份结核病可疑症状筛查问卷,回收628份,有效问卷623份。问卷调查表的主要内容包括:(1)咳嗽、咳痰持续2周;(2)反复咳出带血的痰;(3)反复发热持续2周以上;(4)夜间经常出汗;(5)无法解释的体质量明显下降;(6)经常容易疲劳或呼吸短促;(7)淋巴结肿大。出现(1)~(7)中1个或多个症状为结核病症状筛查阳性。专家组根据623例受检者的可疑症状问卷筛查、痰涂片显微镜检查、胸部X线摄影、痰培养、结核菌素试验和结核感染T淋巴细胞斑点试验(T-SPOT.TB)等检查结果综合判断,以确诊其中的活动性结核病。并以专家组诊断结果作为参考标准,计算结核病症状筛查在诊断活动性结核病的敏感度、特异度、阳性预测值、阴性预测值、约登指数、Kappa值,评价结核病症状筛查在HIV感染/AIDS患者中筛查结核病的应用价值。结果 现场结核病症状筛查中,结核病症状阳性率为66.29%(413/623),专家组共计确诊113例活动性结核病患者,以此作为参考标准,计算结核病症状筛查活动性结核病的敏感度、特异度、阳性预测值、阴性预测值、约登指数和Kappa 值分别为69.03%(78/113)、34.31%(175/510)、18.89%(78/413)、83.33%(175/210)、0.03和-0.76。结论 结核病症状筛查在HIV感染/AIDS患者中确诊活动性结核病阳性结果与专家组确诊患者比较的约登指数、Kappa值均较低,但症状筛查投入低、操作简单且有效,特别是在医疗资源特别匮乏的边远地区及少数民族地区,可作为排查结核病的预警指标。

关键词: HIV感染/AIDS患者, 结核, 多相筛查, 小地区分析, 数据说明, 统计

Abstract:

Objective To explore the role of tuberculosis (TB) symptom screening in the diagnosis and exclusion of active tuberculosis in HIV/AIDS patients, so as to provide reference for grassroots doctors. Methods A total of 688 HIV/AIDS patients were screened for tuberculosis in “two townships and one town” of Butuo County, Liangshan Yi Autonomous Prefecture, Sichuan Province. A multi-phase screening method was used. Six hundred and eighty-eight TB suspicious symptom screening questionnaire were sent out, 628 were recovered and 623 were effective.TB suspicious symptoms in the questionnaire were: (1) coughing and expectoration lasting for at least 2 weeks; (2) repeatedly coughing with bloody sputum; (3) recurrent fever lasting for more than 2 weeks; (4) frequent sweating at night; (5) unexplained weight loss; (6) frequent fatigue or shortness of breath; (7) lymphadenopathy. Having one or more symptoms of the above (1)~(7) lymphadenopathy. Having one or more symptoms of the above (1)~(7) were defined as positive for TB symptom screening. Basing on suspicious symptom questionnaire screening, sputum smear microscopy, chest X-ray film, sputum culture, tuberculin test and T-lymphocyte spot test (T-SPOT.TB), an expert group made TB diagnosis decisions for those 623 patients. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index and Kappa value of TB symptom screening in the diagnosis of active TB were calculated with the diagnosis result of the expert group as reference standard, and the application value of TB symptom screening in HIV/AIDS patients was evaluated. Results In the field TB symptom screening, the positive rate of TB symptom was 66.29% (413/623). A total of 113 active TB patients were diagnosed by the expert group. Sensitivity, specificity, positive predictive value, negative predictive value, Youden index and Kappa value were 69.03% (78/113), 34.31%(175/510),18.89%(78/413),83.33%(175/210),0.03 and -0.76,respectively. Conclusion The Youden index and Kappa value of TB symptom screening positive in HIV/AIDS patients were relatively low comparing with expert group diagnosis result. However, because of the low cost, simple and effective operation, symptom screening can be used as an early warning indicator for TB screening in remote areas and ethnic minority areas where medical resources are particularly scarce.

Key words: HIV infection/AIDS patients, Tuberculosis, Multiphasic screening, Small area analysis, Data description, statistics