涂阴与涂阳肺结核患者发现方式及发现初期临床症状和体征的对比分析

Comparative analysis of detection methods and clinical features in patients with smear-negative and smear-positive pul-monary tuberculosis

目的通过对涂阴、涂阳肺结核患者的发现方式及发现初期临床症状和体征进行对比分析，为结核病的科学防治提供依据。方法收集2011年1月至2015年6月在广州市胸科医院第一门诊部诊断登记并治疗的肺结核患者2710例，其中涂阳肺结核患者1076例，涂阴肺结核患者1634例。比较涂阳和涂阴肺结核患者发现方式及发现初期临床症状和体征的差异。应用Stata11．0软件进行统计学分析，计数资料采用X^2检验，计量资料采用t检验，以P〈0．05为差异有统计学意义。结果发现初期涂阴患者中74．7％（1220／1634）有咳嗽、咯痰或者咯血症状，涂阳患者中85．4％（919／1076）有咳嗽、咯痰或者咯血症状，差异有统计学意义（X^2=45．00，P〈0．001）。涂阴患者中14．1％（231／1634）有空洞，涂阳患者中48．4％（521／1076）有空洞，差异有统计学意义（X^2=380．30，P〈0．001）。5．4％（88／1634）的涂阴患者与肺结核患者有密切接触史，9．8％（105／1076）的涂阳患者与肺结核患者有密切接触史，差异有统计学意义（X^2=18．80，P％0．001）。涂阴与涂阳肺结核患者通过主动方式发现者占其组内的比率分别为34．2％（559／1634）与13．3％（143／1076），差异有统计学意义（X^2=147．90，P％0．001）。结论涂阳患者在发现方式上，应关注就诊患者、密切接触者；而涂阴患者在发现方式上除了要加强对就诊患者的鉴别诊断及追踪随访管理，还应重点关注健康体检，加强对重点人群的筛查。

Objective This study aimed to analyze the difference of the detection methods and the clinical fea- tures （symptoms and signs） between the patients with smear-negative pulmonary tuberculosis （PTB） and the pa- tients with smear-positive PTB, and to provide scientific evidence for TB control. Methods A total of 2710 PTB patients, who were notified and received treatment at the First Out-patient Department （OPD） of Guangzhou Chest Hospital from Jan 2011 to Jun 2015, were consecutively enrolled in the study including 1634 smear-negative PTB pa- tients and 1076 smear-positive PTB patients based on the bacteriological examination results. A comparative analysis was performed by using the Stata 11.0 software to test the difference of the detection methods as well as the symp- toms and signs between the two groups. Chi-square test and Student＇s t-test were used for statistical comparisons and P〈0.05 was considered to be statistical significance. Results In the early stage of diagnosis, 74.7%（1220/1634） of the smear-negative PTB patients had symptoms of cough, expectoration or hemoptysis, which was significantly lower than the percentage of 85.4%（919/1076） in the smear-positive PTB patients （X^2=45.00, P〈0. 001）. The proportion of cavity in the smear-negative PTB patients was 14. 1% （231/1634）, which was lower than the proportion of 48. 4% （521/1076） in the smear-positive PTB patients （X^2=380. 30, P〈0.001）. The proportion of patients who had a history of close contact with active PTB patient was 5.40//00 （88/1634） and 9.80/00 （105/1076） respectively in the smear-negative and smear-positive PTB patients, the difference of the proportions in the two groups was significant （X^2 =18.80, P〈0. 001）. Furthermore, 34. 2% （559/1634） of the smear-negative PTB patients were detected through the active case-finding method while this proportion was only 13.3% （143/1076） in the smear-positive PTB patients, the difference was significant （X^2= 147.90, P〈0. 001）.Conclusion The typical symptoms and signs indicating TB, such as cough, expectoration and hemoptysis are more common in the patients with smear-positive PTB than appear in the smear-negative PTB patients in the early stage of the disease, which can cause misdiagnosis to the smear-negative PTB patients. Some active case-finding methods can be used to improve the detection of smear-negative PTB patients, including TB high-risk population screening, physical examination, etc. , and the antidiastole and follow-up to TB suspects should be strengthened.