南非疑似结核病的 HIV 感染者快速 C 反应蛋白检测的诊断准确性和临床作用。
Diagnostic accuracy and clinical role of rapid C-reactive protein testing in HIV-infected individuals with presumed tuberculosis in South Africa.
出版信息
Int J Tuberc Lung Dis. 2014 Jan;18(1):20-6. doi: 10.5588/ijtld.13.0519.
OBJECTIVE
To determine the accuracy and role of rapid C-reactive protein (CRP) testing in human immunodeficiency virus (HIV) infected individuals with presumed tuberculosis (TB).
DESIGN
We enrolled HIV-infected adults (≥18 years)with a cough of ≥2 weeks and negative sputum smears for acid-fast bacilli in KwaZulu-Natal, South Africa. Participants were evaluated for pulmonary TB (PTB) by a nurse with rapid CRP, and independently by a physician by chest radiograph. Rapid CRP test results were compared with laboratory CRP and sputum sent for confirmation of TB.
RESULTS
Among 93 participants, 55 (59%) were female, the mean age was 35 years, and the median CD4 count was 177/mm3. Forty-five (54%) participants were diagnosed with PTB. Diagnostic sensitivity and specificity were respectively 95% (95%CI 74–99) and 51%(95%CI 35–66) for rapid CRP >8 mg/l, 87% (95%CI 73–96) and 53% (95%CI 38–68) for nurse assessment, and 69% (95%CI 52–83) and 76% (95%CI 61–87) for physician examination. Combining a negative rapid CRP(≤8 mg/l) with nurse and physician assessments reduced the post-test probability of PTB from 22% to 6% and from 32% to 6%, respectively.
CONCLUSION
Rapid CRP testing helped exclude PTB,and may be a valuable test in assisting nurses and physicians in TB-endemic regions.
目的
确定快速 C 反应蛋白（CRP）检测在疑似结核病（TB）的人类免疫缺陷病毒（HIV）感染者中的准确性及其作用。
设计
我们在南非夸祖鲁-纳塔尔省招募了 HIV 感染的成年人（≥18 岁），这些人咳嗽≥2 周，痰抗酸杆菌涂片阴性。护士用快速 CRP 对参与者进行肺 TB（PTB）评估，医生通过胸部 X 线独立进行评估。将快速 CRP 检测结果与实验室 CRP 和用于确认 TB 的痰液进行比较。
结果
在 93 名参与者中，有 55 名（59%）为女性，平均年龄为 35 岁，中位 CD4 计数为 177/mm3。有 45 名（54%）参与者被诊断为 PTB。快速 CRP＞8mg/l 的诊断灵敏度和特异性分别为 95%（95%CI 74–99）和 51%（95%CI 35–66），护士评估的分别为 87%（95%CI 73–96）和 53%（95%CI 38–68），医生检查的分别为 69%（95%CI 52–83）和 76%（95%CI 61–87）。将阴性快速 CRP（≤8mg/l）与护士和医生评估相结合，将 PTB 的 post-test 概率从 22%分别降低至 6%和 32%至 6%。
结论
快速 CRP 检测有助于排除 PTB，并且可能是协助 TB 流行地区的护士和医生的一项有价值的检测。
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