Chaturvedi N, Cockcroft A
Hampstead Health Authority, London, UK.
Occup Med (Lond). 1992 Nov;42(4):179-82. doi: 10.1093/occmed/42.4.179.
There is uncertainty in the NHS about which individuals should be offered pre-employment screening by chest X-ray and whether this procedure is of value in the detection of tuberculosis. To provide evidence for practice, pre-employment chest X-ray and tuberculin skin test status were examined retrospectively for employees of a health district. Cases were those with an abnormal chest X-ray; referents were a sample of the remainder with a normal chest X-ray. The majority of the population had positive tuberculin skin tests and there was no difference between cases (58 positive out of 68) and referents (170 positive out of 212). Most of the X-ray abnormalities were trivial; four findings were thought significant, but would have caused no problems if undetected and none of these findings was related to tuberculosis. We conclude that in new employees in Hampstead health district, X-ray abnormalities are rare and not predicted by testing tuberculin skin reactivity; neither procedure is justified routinely as a means of screening for tuberculosis. The situation in districts with a high incidence of tuberculosis needs to be investigated.
英国国家医疗服务体系（NHS）对于哪些个体应接受入职前胸部X光筛查以及该检查程序在结核病检测中是否有价值存在不确定性。为了给实际操作提供证据，我们对一个健康区的员工进行了回顾性研究，检查其入职前胸部X光和结核菌素皮肤试验情况。病例组为胸部X光异常者；对照组为其余胸部X光正常者的样本。大多数人结核菌素皮肤试验呈阳性，病例组（68例中有58例阳性）和对照组（212例中有170例阳性）之间无差异。大多数X光异常情况并不严重；有四项检查结果被认为有意义，但即使未被发现也不会引发问题，且这些结果均与结核病无关。我们得出结论，在汉普斯特德健康区的新员工中，X光异常情况罕见，且不能通过结核菌素皮肤反应性检测预测；这两种检查程序作为结核病筛查手段都没有常规应用的合理性。结核病高发区的情况需要进行调查。
