Abstract:

【Abstract】 Objective To analyze the status of diagnosis of pulmonary tuberculosis with negative etiology testing results in China, and to provide scientific basis for improving the diagnosis strategy of etiology negative tuberculosis. Methods According to the voluntary principle of each province, 1761 TB patients with negative etiology testing results were collected from 8 designated TB medical institutions in Shandong, Qinghai, Gansu and Liaoning Provinces registered from June 1, 2017 to May 31, 2018. The medical records, chest films including X-ray photography, digital X-ray photography, CT and laboratory examination results of the patients were reviewed to analyze the diagnosis status in receiving etiological examination, laboratory auxiliary examination and imaging examination. Results Among the 1761 patients, 2.3% (40/1761) of the patients did not carry out sputum smear, 4.9% (87/1761) of the patients only carried out sputum smear one or two times. Patients received sputum culture and molecular biology test accounted for 27.1% (478/1761) and 24.5% (431/1761), respectively. Only 40.2% (708/1761) of patients underwent tuberculin skin test, 34.8% (612/1761) of interferon gamma release test and 44.5% (784/1761) of tuberculosis antibody test. 53.5% (942/1761) of the cases only relied on chest X-ray for diagnosis without any auxiliary laboratory examinations. 16.8% (296/1761) of the chest radiographs were unqualified, and the main problems were blurred image, inappropriate voltage, damage caused by improper preservation, etc. After reviewed by experts, 9.7% (170/1761) of them were misdiagnosed or over diagnosed. Among them, 88.3% (150/170) were inactive tuberculosis, the remaining 11.7% (20/170) were inflammation, tumor and other diseases. Conclusion The standardization of sputum examination for newly diagnosed patients in county tuberculosis designated medical institutions needs to be improved, and the efforts of etiological examination of patients and the ability of distinguishing tuberculosis from inflammation and tumor need to be improved; and the diagnostic process of tuberculosis with negative etiology detection should be standardized.

Key words: Tuberculosis,pulmonary, Diagnosis, Etiological diagnosis, Diagnostic imaging, Health care quality,access,and evaluation