Breen R A M, Leonard O, Perrin F M R, Smith C J, Bhagani S, Cropley I, Lipman M C I
Department of Thoracic Medicine, Royal Free Hospital, London, UK.
Int J Tuberc Lung Dis. 2008 Jan;12(1):44-9.
The diagnosis of tuberculosis (TB) may be rejected in the absence of symptoms such as fever, sweats or weight loss.
To determine how frequently these features and blood test evidence of inflammation were absent in individuals with TB.
Prospective cohort study of 175 unselected subjects diagnosed with TB at a UK TB service between 2003 and 2006.
Eight (5%) subjects identified by screening and 24 (14%) without culture confirmation were excluded. Of the remaining 143, fever, sweats or weight loss were absent in respectively 37%, 39% and 38%. All three symptoms were absent in 25%. In 88 subjects with pulmonary disease, all three symptoms were absent in 20% (10% of smear-positive cases). Overall, C-reactive protein was normal in 15%, erythrocyte sedimentation rate in 21% and lactate dehydrogenase in 55%. In a multivariable model, factors associated with absent symptoms included drug-resistant TB (adjusted odds ratio [aOR] 3.58, P = 0.004) and female sex (aOR 3.15, P = 0.004).
In our population, TB, including pulmonary disease, frequently presented without fever, sweats or weight loss and with normal blood inflammatory markers. This information is of as much relevance to policy makers seeking to improve active case detection as to clinicians and the general public.
在没有发热、盗汗或体重减轻等症状的情况下，结核病（TB）的诊断可能会被否定。
确定这些特征以及炎症的血液检测证据在结核病患者中缺失的频率。
对2003年至2006年期间在英国一家结核病服务机构确诊的175名未经挑选的结核病患者进行前瞻性队列研究。
8名（5%）经筛查发现的患者和24名（14%）未经培养确诊的患者被排除。在其余143名患者中，分别有37%、39%和38%的患者没有发热、盗汗或体重减轻症状。25%的患者这三种症状均无。在88名患有肺部疾病的患者中，20%（涂片阳性病例的10%）的患者这三种症状均无。总体而言，15%的患者C反应蛋白正常，21%的患者红细胞沉降率正常，55%的患者乳酸脱氢酶正常。在多变量模型中，与症状缺失相关的因素包括耐多药结核病（调整后的优势比[aOR]为3.58，P = 0.004）和女性（aOR为3.15，P = 0.004）。
在我们的研究人群中，包括肺部疾病在内的结核病常常在没有发热、盗汗或体重减轻症状且血液炎症标志物正常的情况下出现。这一信息对于寻求改善主动病例发现的政策制定者、临床医生和公众同样重要。
