Bah B, Massari V, Sow O, Siriwardana M, Camara L M, Larouzé B, Murray J F
National Tuberculosis Program, Conakry, Guinea.
Int J Tuberc Lung Dis. 2002 Jul;6(7):592-8.
Tuberculosis suspects with negative sputum smears for acid-fast bacilli (AFB) may have either pulmonary tuberculosis (PTB) or some other pulmonary disease (non-PTB). The aim of this study was to improve the differentiation between PTB and non-PTB.
We enrolled 396 tuberculosis suspects 15 years of age or older who had cough of 21 days or longer and three negative AFB smears. Non-PTB was diagnosed by clinical and radiographic responses to amoxicillin; smear-negative PTB was diagnosed by positive culture for Mycobacterium tuberculosis or response to antituberculosis chemotherapy.
Multivariate analysis, without X-ray variables, of 79 patients with a final diagnosis of non-PTB and 110 patients with smear-negative PTB indicated that age less than 37 years, family contact with TB, never having been married, loss of weight, lack of expectoration, human immunodeficiency virus (HIV) seropositivity, and tuberculin reactivity were significantly associated with PTB. When the initial X-ray findings were included, age younger than 37 years, lack of expectoration, HIV seropositivity, and tuberculin reactivity remained in the model, and cavitation and patchy densities were significantly associated.
The response to 10 days of amoxicillin and certain demographic, clinical and radiographic characteristics are useful in separating non-PTB from PTB in tuberculosis suspects with negative AFB smears.
痰涂片抗酸杆菌（AFB）阴性的肺结核疑似患者可能患有肺结核（PTB）或其他肺部疾病（非PTB）。本研究的目的是改善PTB与非PTB之间的鉴别诊断。
我们纳入了396例15岁及以上的肺结核疑似患者，这些患者咳嗽21天或更长时间，且AFB涂片三次均为阴性。非PTB通过对阿莫西林的临床和影像学反应进行诊断；涂片阴性的PTB通过结核分枝杆菌培养阳性或对抗结核化疗的反应进行诊断。
对79例最终诊断为非PTB的患者和110例涂片阴性的PTB患者进行的多变量分析（不包括X线变量）表明，年龄小于37岁、有结核病家庭接触史、从未结婚、体重减轻、无咳痰、人类免疫缺陷病毒（HIV）血清学阳性以及结核菌素反应性与PTB显著相关。当纳入初始X线检查结果时，年龄小于37岁、无咳痰、HIV血清学阳性以及结核菌素反应性仍保留在模型中，并且空洞形成和斑片状密度影显著相关。
对于AFB涂片阴性的肺结核疑似患者，阿莫西林治疗10天的反应以及某些人口统计学、临床和影像学特征有助于区分非PTB和PTB。
