Fournet N, Sanchez A, Massari V, Penna L, Natal S, Biondi E, Larouzé B
INSERM, UMR-S 707, Université Pierre et Marie Curie, Paris 6, Paris F-75012, France.
Public Health. 2006 Oct;120(10):976-83. doi: 10.1016/j.puhe.2006.06.004. Epub 2006 Sep 11.
Tuberculosis (TB) is highly endemic in Rio de Janeiro State prisons. In addition to TB screening at entry and passive case detection, active case identification may be warranted.
To develop and evaluate performances of scores aimed at identifying "tuberculosis suspects" in order to target TB screening among inmates.
Systematic chest X-ray screening was carried out in two prisons (n=1910). TB was diagnosed among individuals with X-ray abnormalities by sputum microscopic examination and culture or, if bacteriological results were negative, by response to TB treatment. Using this strategy as a reference, the clinical score proposed in WHO guidelines "TB Control in Prisons" was evaluated. Using the same variables in a logistic regression comparing TB and non-TB cases, another score was developed and evaluated. Finally, a 'new score', based on socio-demographic and clinical variables was developed and evaluated.
When applied to our study population (prevalence of active TB: 4.6%), these scores missed many TB cases (sensitivities: 56%, 72%, 74%, respectively). Among the "TB suspects", the probability of finding TB cases was low (positive predictive value: 10%). The scores had high negative predictive values (>97%); specificities (75%, 60%, 67%) were low. Performances were similarly poor for smear-negative and smear-positive cases.
The scores investigated performed poorly and would be unhelpful to target TB screening. Therefore, systematic X-ray screening may be considered, at least during the initial stages of the reinforced TB programme, in order to reduce the impressive burden of TB.
结核病在里约热内卢州的监狱中高度流行。除了入狱时的结核病筛查和被动病例检测外，主动病例识别可能也是必要的。
开发并评估旨在识别“结核病疑似病例”的评分系统，以便在囚犯中进行有针对性的结核病筛查。
在两所监狱（n = 1910）中进行了系统性胸部X线筛查。通过痰涂片显微镜检查和培养对X线异常的个体进行结核病诊断，或者如果细菌学结果为阴性，则根据对结核病治疗的反应进行诊断。以该策略为参考，对世界卫生组织《监狱结核病控制》指南中提出的临床评分进行了评估。在比较结核病和非结核病病例的逻辑回归中使用相同变量，开发并评估了另一个评分系统。最后，基于社会人口统计学和临床变量开发并评估了一个“新评分”。
应用于我们的研究人群（活动性结核病患病率：4.6%）时，这些评分系统遗漏了许多结核病病例（敏感性分别为56%、72%、74%）。在“结核病疑似病例”中，发现结核病病例的概率较低（阳性预测值：10%）。这些评分系统具有较高的阴性预测值（>97%）；特异性较低（分别为75%、60%、67%）。涂片阴性和涂片阳性病例的表现同样较差。
所研究的评分系统表现不佳，无助于有针对性地进行结核病筛查。因此，至少在强化结核病项目的初始阶段，可以考虑进行系统性X线筛查，以减轻结核病的沉重负担。
