结核性胸腔积液诊断模拟评分系统的临床探讨

Clinical study of a diagnostic analogue scoring system for tuberculous pleural effusions

目的探讨结核性胸腔积液诊断模拟评分系统。方法采用病例对照研究的方法选择结核性胸腔积液患者77例作为病例组，非结核性胸腔积液患者41例作为对照组。选择与结核性胸腔积液相关的危险因素和症状进行多元Logistic分析，计算各变量的权重分值，建立临床诊断模拟评分系统。应用受试者工作特征曲线确定结核性胸腔积液患者的评分最佳临界值。结果根据此诊断模拟评分系统对两组进行评分，病例组平均（17±6）分，对照纽平均（4±3）分，两组比较差异有统计学意义（P〈0．01）。选取评分8．5分作为鉴别结核性胸腔积液和非结核性胸腔积液的临界值，当评分≥8．5分时诊断结核性胸腔积液的敏感度是90．91％（70／77），特异度是95．12％（39／41），诊断准确度是92．37％（109／118）。结论结核性胸腔积液诊断模拟评分系统有助于结核性胸腔积液的早期诊断，特别对基层医院和非结核专业医生，有待于进一步扩大研究。

Objective To investigate the diagnostic analogue scoring system of tuberculous pleu- ral effusions （TPE）. Methods A hospital-based case-control study was undertaken among a cohort comprised of 77 TPE patients and 41 patients with non-tuberculous pleural effusion. Symptoms and risk factors described in the data were compared between the two groups. Significant and borderline risk fac- tors and symptoms were selected to undergo multivariate logistic regression. A high risk analogue scoring system was constructed according to the weighted numerical scores of every variable. The optimal cut off for TPE patients were determined by using the ROC curve. Results The average score was significantly higher of the TPE patients than that of the control group patients （ mean 17 ±6 vs 4 ± 3, P 〈 0. 01 ）. The cut off value of the analogue scoring system of TPE patients were 8.5 points, when the cut off value washigher or equal to 8.5 points, the sensitivity was 90. 91% （ 70/77 ）, the specificity was 95.12% （39/41） , the diagnostic accuracy was92.37% （109/118）. Conclusions The diagnostic analogue scoring system will be helpful to detect ear- liy TPE patients in hospital at low level, especially for non-tuberculosis professional physician. This screening strategy need to be demonstrated furtherly.