Glassroth J, Bailey W C, Hopewell P C, Schecter G, Harden J W
Department of Medicine, Northwestern University, Chicago, Illinois.
Am Rev Respir Dis. 1990 May;141(5 Pt 1):1236-40. doi: 10.1164/ajrccm/141.5_Pt_1.1236.
Because of the effectiveness of isoniazid in treating tuberculosis infection, progression to tuberculosis should be largely preventable. Thus, each case of tuberculosis that occurs may be viewed as a "failure" of the prevention system. We studied the reasons for these "failures" at three centers in different geographic areas in the United States. Two hundred seventy-nine patients with bacteriologically confirmed tuberculosis were evaluated by means of a questionnaire. Our results suggest three main reasons for these missed opportunities of tuberculosis prevention. (1) Patients are out of the health care system until they develop tuberculosis. (2) Patients are in the system but are either not screened for tuberculous infection or, if screened, are not offered preventive therapy when it is appropriate. (3) Because of false negative skin test results, screening may be ineffective at the time it is applied. Advances in tuberculosis prevention will require attention to these areas.
由于异烟肼在治疗结核感染方面的有效性，结核病的进展在很大程度上应是可预防的。因此，每一例发生的结核病都可被视为预防系统的“失败”。我们在美国不同地理区域的三个中心研究了这些“失败”的原因。通过问卷调查对279例细菌学确诊的结核病患者进行了评估。我们的结果提示了结核病预防这些错失机会的三个主要原因。（1）患者在患结核病之前脱离了医疗保健系统。（2）患者在医疗系统中，但未接受结核感染筛查，或者即使接受了筛查，在合适的时候也未得到预防性治疗。（3）由于结核菌素皮肤试验结果为假阴性，筛查在应用时可能无效。结核病预防的进展将需要关注这些方面。
