Schwartz Nadav, Wagner Sarah A, Keeler Sean M, Mierlak Julian, Seubert David E, Caughey Aaron B
Department of Obstetrics and Gynecology, NYU School of Medicine, New York, New York 10016, USA.
Am J Perinatol. 2009 Jun;26(6):447-51. doi: 10.1055/s-0029-1214244. Epub 2009 Mar 4.
We reviewed our practice of universal tuberculosis (TB) screening in an at-risk pregnant population with regards to utility and patient compliance. The Gouverneur Healthcare Services prenatal database was analyzed for compliance with TB screening. Age, ethnicity, country of origin, and education level were also analyzed. Of 4049 patients, 95.0% were compliant with their purified protein derivative (PPD) testing. Universal screening identified 1935 (50.4%) PPD+ patients, with chest X-rays (CXR) available for 95.1%. Only one patient had a CXR consistent with active TB, although sputum testing was negative for acid-fast bacilli. Asian women were more likely to be PPD-compliant (adjusted odds ratio [aOR]: 4.94, 95% confidence interval [CI]: 2.34 to 10.45). Similarly, PPD+ Asian women were more likely to be compliant with CXR (aOR: 12.67, 95% CI: 3.44 to 46.7). U.S.-born women were significantly less likely to be compliant with PPD (aOR: 0.44, 95% CI: 0.30 to 0.64) or with CXR (aOR: 0.22, 95% CI: 0.08 to 0.61). Universal prenatal TB screening is associated with excellent compliance rates and is an effective way to identify a high prevalence of latent TB, but not active disease.
我们回顾了针对高危孕妇群体进行的普遍结核病(TB)筛查在实用性和患者依从性方面的情况。分析了ouverneur医疗服务机构的产前数据库中结核病筛查的依从情况。还分析了年龄、种族、原籍国和教育水平。在4049名患者中,95.0%的患者完成了结核菌素纯蛋白衍生物(PPD)检测。普遍筛查发现了1935名(50.4%)PPD检测呈阳性的患者,其中95.1%的患者进行了胸部X光(CXR)检查。尽管痰涂片抗酸杆菌检测为阴性,但只有一名患者的胸部X光检查结果符合活动性结核病表现。亚洲女性更有可能完成PPD检测(校正比值比[aOR]:4.94,95%置信区间[CI]:2.34至10.45)。同样,PPD检测呈阳性的亚洲女性更有可能完成胸部X光检查(aOR:12.67,95%CI:3.44至46.7)。在美国出生的女性完成PPD检测(aOR:0.44,95%CI:0.30至0.64)或胸部X光检查(aOR:0.22,95%CI:0.08至0.61)的可能性显著较低。普遍的产前结核病筛查具有很高的依从率,是识别潜伏性结核病高患病率的有效方法,但无法识别活动性疾病。