胸部 X 光在资源有限国家中 HIV 感染儿童结核病诊断中的价值：ANRS 12229-PAANTHER 01 研究。

Value of chest X-ray in TB diagnosis in HIV-infected children living in resource-limited countries: the ANRS 12229-PAANTHER 01 study.

机构信息

Service de Radiologie Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.

Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia, Centre Institut national de la santé et de la recherche médicale Unité 1219, Université de Bordeaux, Bordeaux Population Health, Bordeaux, France.

出版信息

Int J Tuberc Lung Dis. 2018 Aug 1;22(8):844-850. doi: 10.5588/ijtld.18.0122.

DOI:10.5588/ijtld.18.0122

PMID:29991391

Abstract

OBJECTIVE

To evaluate inter-reader agreement and diagnostic accuracy of chest radiography (CXR) in the diagnosis of tuberculosis (TB) in children with human immunodeficiency virus (HIV) infection.

DESIGN

HIV-infected children with clinically suspected TB were enrolled in a prospective study conducted in Burkina Faso, Cambodia, Cameroon and Viet Nam from April 2010 to December 2014. Three readers-a local radiologist, a paediatric pulmonologist and a paediatric radiologist-independently reviewed the CXRs. Inter-reader agreement was then assessed using the κ coefficient. Diagnostic accuracy of CXR was assessed in culture-confirmed cases and controls.

RESULTS

A total of 403 children (median age 7.3 years, interquartile range 3.5-9.7; 49.6% males) were enrolled. Inter-reader agreement was as follows: between local radiologist and paediatric pulmonologist, κ = 0.36 (95%CI 0.27-0.45); local radiologist and paediatric radiologist, κ = 0.16 (95%CI 0.08-0.24); and paediatric pulmonologist and paediatric radiologist, κ = 0.30 (95%CI 0.21-0.40). Among 51 cases and 151 controls, after a consensus, CXR had a sensitivity of 71.4% (95%CI 58.8-84.1) and a specificity of 50.0% (95%CI 41.9-58.1). Alveolar opacities and enlarged lymph nodes on CXR had limited specificity for TB (64.7% and 70.2%, respectively). Miliary and/or nodular opacities patterns on CXR were more specific to TB (specificity 94.3%).

CONCLUSION

CXR showed poor-to-fair inter-reader agreement and limited diagnostic accuracy for TB in HIV-infected children, likely due to comorbidities. Radiological criteria for this specific population require further investigation.

摘要

目的

评估胸部 X 线摄影（CXR）在诊断人类免疫缺陷病毒（HIV）感染儿童结核病（TB）中的读者间一致性和诊断准确性。

设计

2010 年 4 月至 2014 年 12 月，在布基纳法索、柬埔寨、喀麦隆和越南进行了一项前瞻性研究，纳入了临床疑似患有 TB 的 HIV 感染儿童。三位读者——一名当地放射科医生、一名儿科肺病专家和一名儿科放射科医生——独立审查了 CXR。然后使用κ系数评估读者间的一致性。CXR 的诊断准确性在培养确诊病例和对照组中进行了评估。

结果

共纳入 403 名儿童（中位年龄 7.3 岁，四分位间距 3.5-9.7；49.6%为男性）。读者间的一致性如下：当地放射科医生和儿科肺病专家之间，κ=0.36（95%置信区间 0.27-0.45）；当地放射科医生和儿科放射科医生之间，κ=0.16（95%置信区间 0.08-0.24）；儿科肺病专家和儿科放射科医生之间，κ=0.30（95%置信区间 0.21-0.40）。在 51 例病例和 151 例对照组中，经过共识后，CXR 的敏感性为 71.4%（95%置信区间 58.8-84.1），特异性为 50.0%（95%置信区间 41.9-58.1）。CXR 上的肺泡混浊和淋巴结肿大对 TB 的特异性有限（分别为 64.7%和 70.2%）。CXR 上的粟粒状和/或结节状混浊模式对 TB 更具特异性（特异性 94.3%）。