HIV/AIDS病人结核病可疑症状筛查问卷初探

TB screening questionnaire in diagnosis and ruling out active TB in people living with HIV/AIDS

目的探讨结核病筛查问卷在HIV/AIDS病人中确诊和排除活动性结核的作用,为基层医生HIV/AIDS中活动性结核的诊断提供参考。方法 2006年9月至2007年2月,对4个县HIV/AIDS病人进行连续纳入,通过结核病筛查问卷收集了每个患者的结核病可疑症状信息,并对部分患者进行了进一步的临床检查。分析了单一症状,多个症状在活动性结核诊断上的敏感度、特异度、似然比、验后概率。分析采用的金标准是当地艾滋病诊断治疗专家组根据痰检、X线胸片等定诊结果。结果我国当前采用的HIV/AIDS病人结核病筛查问卷灵敏度为100%,特异度为65.6%。HIV/AIDS病人中可疑症状出现频次排序依次为:咳嗽、咳痰、夜间盗汗、和容易疲劳。出现痰中带血、反复低烧的患者,患活动性结核的概率显著增加。单一症状分析,咳嗽、咳痰在诊断活动性结核上灵敏度最高为92.1%,特异度为73.8%。咳嗽、咳痰阴性是排除活动性结核的有力指标。可疑症状筛查阳性患者中,出现1～3个症状的可疑者占85.4%,发现了78.6%的确诊活动性结核。仅有1个症状可疑者,验后概率为5%,同时,拥有2～5个可疑症状的患者,验后概率均稳定在12%左右,应受到同等重视。结论结核病筛查问卷筛查成本低且有效。在资源有限,缺少诸如培养条件地区,简单可行的筛查问卷是发现活动性结核的有力工具。

Objective The purpose of this study is to determine the role of TB screening questionnaire in diagnosis and ruling out active TB in people living with HIV/AIDS,and provide reference for basic level doctors. Methods HIV/AIDS patients were consecutively enrolled in 4 counties during Sep.2006 to Feb.2007.For each HIV/AIDS patient,TB suspicious symptoms were obtained through TB screening questionnaire,and part of patients received further clinical evaluation.Sensitivity,specificity,likelihood ratios,and post-test probability were analyzed for any single symptom,and combination of multiple symptoms.The gold standard is the diagnosis result by sputum smear,X ray,and clinical expert committee. Results Current TB screening questionnaire adopted by China has 100% sensitivity and 65.6% specificity.The highest frequency of symptoms occurred in HIV/AIDS patients were： cough,night sweat,and fatigue.The probability of active TB increased significantly in patients with bloody sputum and those with recurrent fever.The single symptom of cough has the highest 92.1% sensitivity among all single symptoms,and its specificity is 73.8%.Cough negative is a strong indicator in ruling out active TB.85.4% of HIV/AIDS patients have 1 to 3 symptoms.Active TB detected among them contributes to 78.6% of all diagnosed TB cases.For HIV/AIDS with only 1 TB suspicious symptom,the post test probability of active TB is 5%;while for those with 2 to 5 symptoms,this probability is around 12%.Therefore patient with 2 to 5 symptoms are equally important. Conclusion TB screening questionnaire constitute a low-cost and effective tool to increase detection of active TB in people living with HIV/AIDS,especially in resource-constraint setting,simple and feasible screening could facilitate the detection.