县医院葡萄膜炎患者常规结核筛查的效用。
The utility of routine tuberculosis screening in county hospital patients with uveitis.
机构信息
Doheny Eye Institute, Los Angeles, California, USA Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
出版信息
Br J Ophthalmol. 2014 Aug;98(8):1091-5. doi: 10.1136/bjophthalmol-2013-303937. Epub 2014 Jan 31.
BACKGROUND/AIM: To evaluate the utility of tuberculosis (TB) screening in diagnosing ocular TB in uveitis patients in a government-funded hospital.
METHODS
The charts of 142 consecutive patients seen during August 2011-July 2012 at the Los Angeles County Hospital uveitis clinic were reviewed for manifestation/laterality of uveitis, purified protein derivative (PPD) test results, interferon γ release assay, chest x-ray, birthplace, treatment history and diagnosis. 'Presumed TB-uveitis' was diagnosed when patients had positive TB screening and favourable response to anti-TB therapy, and definite ocular TB when Mycobacterium tuberculosis' presence was demonstrated. Post-test probabilities were determined.
RESULTS
TB screening was positive in 21.1%. Six patients were diagnosed with TB-related uveitis: one definite, four presumed and one systemic TB with uveitis. With regard to PPD positivity, being foreign-born was the only statistically significant factor with OR of 2.26 (95% CI 1.01 to 5.13; p<0.01) if born in Mexico and 4.90 (95% CI 1.74 to 13.83; p<0.01) if born in other foreign countries. The post-test probabilities of a positive PPD in a uveitis patient showed a 17.2% (overall) or 30.3% (foreign-born patients) chance of ocular TB.
CONCLUSIONS
PPD skin test plays an important role in the diagnosis of TB-associated uveitis in high-risk groups, such as immigrants from TB endemic regions.
背景/目的：评估在一家政府资助的医院中，对葡萄膜炎患者进行结核（TB）筛查以诊断眼部 TB 的效用。
方法
回顾了 2011 年 8 月至 2012 年 7 月在洛杉矶县医院葡萄膜炎诊所就诊的 142 例连续患者的图表，以评估葡萄膜炎的表现/侧别、纯化蛋白衍生物（PPD）试验结果、干扰素γ释放试验、胸部 X 线片、出生地、治疗史和诊断。当患者 TB 筛查阳性且对抗 TB 治疗反应良好，以及证明存在结核分枝杆菌时，诊断为“疑似 TB-葡萄膜炎”；如果存在结核分枝杆菌，则诊断为明确的眼部 TB。确定了后验概率。
结果
TB 筛查呈阳性的占 21.1%。有 6 例患者被诊断为与 TB 相关的葡萄膜炎：1 例明确，4 例疑似，1 例全身性 TB 合并葡萄膜炎。关于 PPD 阳性，出生在国外是唯一具有统计学意义的因素，出生在墨西哥的 OR 为 2.26（95%CI 1.01 至 5.13；p<0.01），出生在其他外国的 OR 为 4.90（95%CI 1.74 至 13.83；p<0.01）。葡萄膜炎患者 PPD 阳性的后验概率显示，眼部 TB 的机会为 17.2%（总体）或 30.3%（出生在国外的患者）。
结论
PPD 皮肤试验在外来移民等高危人群中对诊断与 TB 相关的葡萄膜炎具有重要作用，这些人来自 TB 流行地区。
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