胸部 X 线摄影在重症监护病房中对肺结核的疑似诊断和诊断中的作用。

The role of chest radiography in the suspicion for and diagnosis of pulmonary tuberculosis in intensive care units.

机构信息

Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.

出版信息

Int J Tuberc Lung Dis. 2009 Nov;13(11):1380-6.

PMID:19861010

Abstract

BACKGROUND

The role of chest radiography (CXR) in the clinical diagnosis and suspicion of pulmonary tuberculosis (PTB) remains uncertain in the intensive care unit (ICU) setting.

DESIGN

This case-control study compared the radiographic findings between ICU patients with and without co-existing PTB to define any predictive patterns for the diagnosis of PTB. Further analysis aimed to elucidate the impact of CXR on the clinical suspicion of PTB.

RESULTS

Eighty-nine (89) patients with PTB and an equal number of matched controls were evaluated. Consolidation was the most frequent radiographic pattern. There were no specific predictors for diagnosing PTB in the ICU. Of 89 patients, 55 (62.9%) had a delay in clinical suspicion of PTB. The time from ICU admission to TB diagnosis was significantly delayed in the group without clinical suspicion (30.7 vs. 5.3 days, P < 0.001). In multivariate analysis, a history of PTB was significantly associated with the clinical suspicion of PTB (OR 7.94, P = 0.012), but CXR patterns were not.

CONCLUSION

CXR does not contribute as much as expected in the clinical diagnosis and suspicion of PTB in the ICU setting.

摘要

背景

在重症监护病房（ICU）环境中，胸部 X 线摄影（CXR）在肺结核（PTB）的临床诊断和疑似病例中的作用仍不确定。

设计

本病例对照研究比较了合并和不合并 PTB 的 ICU 患者的影像学表现，以确定 PTB 诊断的任何预测模式。进一步的分析旨在阐明 CXR 对 PTB 临床疑似病例的影响。

结果

评估了 89 例 PTB 患者和 89 例匹配对照。实变是最常见的影像学表现。在 ICU 中，没有针对 PTB 的特定预测因子。在 89 例患者中，有 55 例（62.9%）对 PTB 的临床疑似病例有延迟。无临床疑似病例组从 ICU 入院到确诊 TB 的时间明显延迟（30.7 天 vs. 5.3 天，P < 0.001）。在多变量分析中，PTB 病史与 PTB 的临床疑似病例显著相关（OR 7.94，P = 0.012），但 CXR 模式则不然。