Kumar N, Bhargava S K, Agrawal C S, George K, Karki P, Baral D
BP Koirala Institute of Health Sciences, Dharan, Nepal.
JNMA J Nepal Med Assoc. 2005 Oct-Dec;44(160):138-42.
Radiology plays an important role in the diagnosis of pulmonary tuberculosis. Many medical practitioners believe in and rely primarily on the chest x-ray for the diagnosis of pulmonary tuberculosis. This study attempts to evaluate the reliability and validity of chest radiographs. This study was carried out in the tuberculosis clinic of BPKIHS. 75 radiographs were chosen for the study and viewed by 25 physicians of varying qualifications. Their findings were compared with the gold standard. The overall sensitivity and specificity was 78% and 51% respectively. There was poor agreement between the best physician and the best radiologist. This study has demonstrated an unsatisfactory sensitivity and specificity of chest x-rays in the diagnosis of pulmonary tuberculosis. The over-diagnosis and over-treatment due to chest x-rays could lead to an unmanageable burden on the resources of a poor country like Nepal. Private practitioners should be made aware about the importance of bacteriological diagnosis of tuberculosis before initiating drug therapy.
放射学在肺结核的诊断中起着重要作用。许多医学从业者主要依靠胸部X光片来诊断肺结核。本研究旨在评估胸部X光片的可靠性和有效性。该研究在BPKIHS的结核病诊所进行。选取了75张X光片用于研究，并由25名资质各异的医生进行阅片。他们的诊断结果与金标准进行了比较。总体敏感度和特异度分别为78%和51%。最佳医生和最佳放射科医生之间的诊断一致性较差。本研究表明，胸部X光片在肺结核诊断中的敏感度和特异度并不理想。因胸部X光片导致的过度诊断和过度治疗可能会给尼泊尔这样的贫穷国家的资源带来难以承受的负担。在开始药物治疗之前，应让私人执业医生了解结核病细菌学诊断的重要性。
