论文部分内容阅读
背景:对东非首都的两所大学医院的住院病人进行了阐明呼吸系疾患病因的广泛的前瞻性研究。目的:为了明确来自布隆迪,布琼布拉(111例)及坦桑尼亚,达累斯萨拉姆(71例)痰涂片显微镜检查抗酸杆菌阴性住院结核病人与非结核呼吸系病人的不同特点。设计:回顾整理182名病例的临床表现、放射学异常及实验室结果,首先使用单一变数,再使用多变数(分段对数回归)分析,以取得每一项因素对最终诊断的价值。结果:182名两次或更多次抗酸杆菌涂片阴性病人中,41名为结核病,141名为非结核病,分段回归分析显示,四种易于确认的症状出现于结核病:1)咳嗽多于21天;2)15天以上的胸痛;3)无喀痰;4)无气短。以上述四项中任何二项用于结核病诊断,其敏感性为85％、特异性为67％;以任何三项用于诊断,敏感性为49％,特异性为86％。多变数分析显示,增加淋巴结增大与红血细胞压积小于30％则可增加鉴别力度。结论:本项方法学探讨,为抗酸杆菌涂片阴性住院病人中结核病诊断提供了一种手段,在这种背景下,单一的简单的临床症状有助于诊断。有必要在疑似结核的门诊病人中进行同样的研究,以构成一个完整体系。
Background: Extensive prospective studies of inpatients at two university hospitals in East Africa’s capital to elucidate the etiology of respiratory disorders. Objectives: To identify different characteristics of sputum smear microscopy in patients with acid-fast bacilli-negative hospitalized tuberculosis and non-tuberculosis respiratory patients from Burundi, Bujumbura (111) and Dar es Salaam, Tanzania (71). Design: A retrospective review of 182 patients with clinical manifestations, radiological abnormalities and laboratory results, first using a single variable, and then using multivariate (piecewise logistic regression) analysis to obtain the value of each factor for the final diagnosis. RESULTS: Out of 182 patients with two or more acid-fast bacilli smears negative, 41 were tuberculosis and 141 were non-tuberculosis. A piecewise regression analysis revealed four easily identifiable symptoms in tuberculosis: 1) Cough At 21 days; 2) chest pain over 15 days; 3) no reflex; and 4) no shortness of breath. For any two of the above four items for tuberculosis diagnosis, the sensitivity is 85% and the specificity is 67%; for any three items, the sensitivity is 49% and the specificity is 86%. Multivariate analysis showed that increasing lymph node enlargement and hematocrit less than 30% increased discrimination. CONCLUSIONS: This methodological discussion provides a means of diagnosing tuberculosis in acid-fast bacilli-negative inpatients, in which context a single, simple clinical symptom is amenable to diagnosis. It is necessary to carry out the same research in outpatients with suspected tuberculosis to form a complete system.