诊断质量评估在病原学阴性肺结核诊断中的应用

Application of diagnostic quality assessment in the diagnosis of pathogen negative pulmonary tuberculosis

目的对贵阳市病原学阴性肺结核开展诊断质量评估,以期降低过诊、误诊率,规范诊断,提高贵阳市病原学阴性肺结核的诊断质量。方法收集2019—2020年1454份病原学阴性肺结核资料,分析其病案资料、胸部影像和实验室检查结果,现场开展诊断质量评估。结果过诊、误诊率为15.96%,其中过诊率为12.72%,误诊率为3.24%。对比两年的评估结果,2020年较2019年过诊误诊率下降26.64%,差异有统计学意义(χ^(2)=5.578,P<0.05)。开展结核菌素试验、γ-干扰素释放试验、抗结核抗体检查,2020较2019年分别上升了94.01%、155.34%、35.12%。结论建议成立市级、县(区)级结核病质控组,规范病原学阴性肺结核诊断流程,科学、合理地开展各项辅助检查,提高医生的诊断能力。

Objective To evaluate the diagnosis quality of pathogenic negative tuberculosis in Guiyang City,in order to reduce the rate of over diagnosis and misdiagnosis,standardize diagnosis,and improve the diagnosis quality of pathogenic negative tuberculosis in Guiyang City.Methods 1454 cases of pathogenic negative tuberculosis were collected from 2019 to 2020.The data of the case,chest image and laboratory examination were collected,and the quality of diagnosis was evaluated on site.Results The over and misdiagnosis rate of over diagnosis was 15.96%,of which the rate of over diagnosis was 12.72%,and the misdiagnosis rate was 3.24%.Compared with the results of two years’evaluation,the misdiagnosis rate of the patients in 2020 was 26.64%lower than that in 2019,with statistically significant difference(χ^(2)=5.578,P<0.05).The results showed that the test of tuberculin,interferonγ-release and anti-tuberculosis antibody were carried out,with an increase of 94.01%,155.34% and 35.12% respectively in 2020 compared with 2019.Conclusion It is necessary to establish a city and county(district)tuberculosis quality control group,to standardize the diagnosis process of pathogenic negative tuberculosis,scientifically and rationally develop pathogenic negative tuberculosis diagnosis,and improve doctors’diagnosis ability.