Aris E A, Bakari M, Chonde T M, Kitinya J, Swai A B
Department of Internal Medicine, Muhimbili University College of Health Sciences, University of Dar es Salaam, Tanzania.
East Afr Med J. 1999 Nov;76(11):630-4.
To determine diagnostic criteria for tuberculosis among sputum smear acid fast bacilli negative patients with chronic cough, based on symptoms, signs and simple laboratory tests.
A two-month prospective follow up study.
Muhimbili Medical Centre, Dar es Salaam, Tanzania.
One hundred and seventy- eight consecutive patients admitted between 1st November, 1994 and 31st March, 1995 with chronic productive cough.
Sputum smear acid fast bacilli (AAFB) negative with TB, discriminating ability of clinical and laboratory parameters.
Forty three (24.2%) were sputum smear positive for acid fast bacilli (AAFB). In 90 (50.6%) patients, AAFB could be isolated in specimen other than sputum and in 45 (25.3%) no AAFB could be isolated. In a univariate analysis of all symptoms, signs and laboratory test results, cough of four or more weeks, haemoptysis, oral candidiasis, chest consolidation, pleural effusion, mid zone and upper zone chest x-ray opacities were significantly different between sputum AAFB negative TB and non TB patients. Discriminant analysis revealed six highly significant variables: Mantoux reaction, pleural effusion, Kaposi's lesion, cervical lymphadenopathy, matted lymph node, mid zone and upper zone CXR infiltrates. From these variables an equation was derived to calculate the probability that a sputum smear negative patient had tuberculosis. Then a scoring system was developed that classified correctly 84% of cases of sputum AAFB negative patients into tuberculosis or non tuberculosis.
In sputum smear AAFB negative patient clinically suspected to have tuberculosis, Mantoux reaction, cervical lymphadenopathy, matted lymph nodes, absence of mid lower zone infiltration on CXR and presence of pleural effusion could be used for presumptive diagnosis, but they would not make a therapeutic trial unnecessary.
基于症状、体征和简单实验室检查，确定慢性咳嗽且痰涂片抗酸杆菌阴性患者的结核病诊断标准。
为期两个月的前瞻性随访研究。
坦桑尼亚达累斯萨拉姆的穆希姆比利医疗中心。
1994年11月1日至1995年3月31日期间连续收治的178例慢性咳痰患者。
痰涂片抗酸杆菌（AAFB）阴性的结核病患者、临床和实验室参数的鉴别能力。
43例（24.2%）痰涂片抗酸杆菌阳性（AAFB）。90例（50.6%）患者的非痰标本中可分离出抗酸杆菌，45例（25.3%）未分离出抗酸杆菌。对所有症状、体征和实验室检查结果进行单因素分析发现，痰涂片抗酸杆菌阴性的结核病患者与非结核病患者在咳嗽四周或更长时间、咯血、口腔念珠菌病、肺部实变、胸腔积液、中肺野和上肺野胸部X光片阴影方面存在显著差异。判别分析显示六个高度显著的变量：结核菌素试验反应、胸腔积液、卡波西肉瘤病变、颈部淋巴结病、融合淋巴结、中肺野和上肺野胸部X光片浸润。从这些变量得出一个方程，用于计算痰涂片阴性患者患结核病的概率。然后制定了一个评分系统，该系统将84%的痰涂片抗酸杆菌阴性患者正确分类为结核病或非结核病。
对于临床怀疑患有结核病的痰涂片抗酸杆菌阴性患者，结核菌素试验反应、颈部淋巴结病、融合淋巴结、胸部X光片无中下肺野浸润以及存在胸腔积液可用于初步诊断，但这些检查并不能使治疗性试验变得不必要。
