Gourevitch M N, Teeter R, Schoenbaum E E, Klein R S
Department of Epidemiology and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Int J Tuberc Lung Dis. 1999 Apr;3(4):321-5.
Self-assessment of tuberculin test results, if accurate, could enhance tuberculosis screening efforts by reducing the need for follow-up visits for skin test reading. We investigated tuberculin test self-assessment in a longitudinal study of tuberculosis infection among drug users.
To determine the accuracy of tuberculin reaction self-assessment by drug users at high risk for tuberculosis infection.
Two readings were compared of the same skin test, performed 48-72 hours after placement: 1) self-assessment using a simple yes-no approach to induration, versus 2) trained examiner reading. Self-assessments were performed immediately prior to trained examiner readings.
Participants were 137 human immunodeficiency virus (HIV) seropositive and 344 HIV-seronegative current and former drug users. Ten per cent (35/344) of reactions read by participants as 'flat' were read by trained examiners as > or =5 mm (54% of which were > or =10 mm). Twenty-three per cent (19/82) of reactions read by trained examiners as > or =10 mm and 32% (35/110) of reactions read by trained examiners as being > or =5 mm were self-read by participants as 'flat'. Sensitivity (0.68) and specificity (0.83) of self-read tuberculin reactions were sub-optimal. Inter-reader reliability was poorer between participants and trained examiners than between trained examiners.
Self-assessments of tuberculin skin test responses by drug users with or at risk for HIV infection are not reliable.
如果结核菌素试验结果的自我评估准确，可减少皮肤试验结果解读的随访需求，从而加强结核病筛查工作。我们在一项针对吸毒者结核病感染的纵向研究中调查了结核菌素试验的自我评估情况。
确定结核病感染高危吸毒者对结核菌素反应自我评估的准确性。
对同一皮肤试验进行两次读数比较，皮肤试验在放置后48 - 72小时进行：1）使用简单的硬结是与否方法进行自我评估，与2）由经过培训的检查人员读数。自我评估在经过培训的检查人员读数之前立即进行。
参与者包括137名人类免疫缺陷病毒（HIV）血清阳性以及344名HIV血清阴性的现吸毒者和既往吸毒者。参与者判定为“无硬结”的反应中，10%（35/344）经经过培训的检查人员判定为≥5毫米（其中54%≥10毫米）。经过培训的检查人员判定为≥10毫米的反应中，23%（19/82）以及判定为≥5毫米的反应中，32%（35/110）被参与者自我判定为“无硬结”。自我读取的结核菌素反应的敏感性（0.68）和特异性（0.83）并不理想。参与者与经过培训的检查人员之间的读数者间可靠性比经过培训的检查人员之间的要差。
HIV感染或有感染风险的吸毒者对结核菌素皮肤试验反应的自我评估不可靠。
