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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 To explore the role of tuberculosis screening questionnaire in the diagnosis and exclusion of active tuberculosis among HIV / AIDS patients and to provide a reference for the diagnosis of active tuberculosis among HIV / AIDS patients in primary care. Methods From September 2006 to February 2007, HIV / AIDS patients in four counties were continuously included. TB suspicious symptom information was collected from each patient through the TB screening questionnaire, and some patients underwent further clinical examination. The sensitivity, specificity, likelihood ratio and post-test probabilities of single symptoms and multiple symptoms in active tuberculosis diagnosis were analyzed. The gold standard used in the analysis is the local diagnosis and treatment of AIDS based on sputum examination, X-ray and other diagnostic results. Results The sensitivity and specificity of the HIV / AIDS screening test in our country were 100% and 65.6%, respectively. The order of frequency of suspicious symptoms in HIV / AIDS patients was as follows: cough, sputum, night sweats, and fatigue. Appeared sputum bloody, repeated low-grade fever, the probability of active tuberculosis increased significantly. Single symptom analysis, cough, sputum in the diagnosis of active tuberculosis the highest sensitivity was 92.1%, specificity was 73.8%. Cough and sputum negative is a strong indicator of active tuberculosis. Suspicious symptoms screening positive patients, 1 to 3 symptoms of suspicious persons accounted for 85.4%, found that 78.6% of confirmed active tuberculosis. There is only 1 suspicious person with 5% post-test probability. Meanwhile, patients with 2 to 5 suspicious symptoms have a stable probability of about 12% after examination, and should receive equal attention. Conclusion The TB screening screening is low cost and effective. In areas with limited resources and lack of areas such as culture conditions, a simple and feasible screening questionnaire is a powerful tool for finding active tuberculosis.