胸部X光可预测有急性呼吸道症状的育龄妇女肺结核病例：一项多中心横断面研究。
Chest X-ray predicts cases of pulmonary tuberculosis among women of reproductive age with acute respiratory symptoms: A multi-center cross-sectional study.
作者信息
Hailemariam Tesfahunegn, Yimer Getnet, Mohammed Hussen, Bisrat Haileleul, Ajeme Tigist, Belina Merga, Oljira Lemessa, Roba Kedir Teji, Belay Fekadu, Andrias Tsion, Ngadaya Esther, Manyazewal Tsegahun
机构信息
Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia.
Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia.
出版信息
J Clin Tuberc Other Mycobact Dis. 2023 Jun 8;32:100383. doi: 10.1016/j.jctube.2023.100383. eCollection 2023 Aug.
BACKGROUND
Tuberculosis (TB) prevalence is increasing among women of reproductive age (WRA) in sub-Saharan Africa, yet undiagnosed and untreated cases remain rather high with serious health and socio-economic consequences. We aimed to assess the prevalence and predictors of TB in WRA seeking health care for acute respiratory symptoms.
METHODS
We consecutively enrolled outpatient WRA with acute respiratory symptoms seeking care at four healthcare facilities in Ethiopia between July 2019 and December 2020. Data on sociodemographic characteristics and clinical information were collected using a structured questionnaire administered by trained nurses. Posteroanterior chest X-ray was performed in non-pregnant WRA and interpreted independently by two radiologists. Sputum samples were collected from all patients and tested for pulmonary TB using Xpert MTB/RIF and/or smear microscopy. Predictors of bacteriologically confirmed TB cases were determined using binary logistic regression, with clinically relevant variables included in the final Firth's multivariate-penalized logistic regression model.
RESULTS
We enrolled 577 participants, of whom 95 (16%) were pregnant, 67 (12%) were living with HIV, 512 (89%) had cough of less than 2 weeks, and 56 (12%) had chest-x-ray findings suggestive of TB. The Overall prevalence of TB was 3% (95% CI: 1.8%-4.7%) with no significant difference observed between patient groups categorized by duration of cough or HIV serostatus ( = 0.9999). In multivariable analysis, TB-suggestive CXR abnormality (AOR 18.83 [95% CI, 6.20-57.18]) and history of weight loss (AOR 3.91 [95% CI, 1.25-12.29]) were associated with bacteriologically-confirmed TB cases.
CONCLUSIONS
We found a high TB prevalence among low-risk women of reproductive age with acute respiratory symptoms. Routine CXR may improve early case detection and thereby TB treatment outcomes.
背景
撒哈拉以南非洲地区育龄妇女的结核病患病率正在上升，但未被诊断和治疗的病例仍然相当多，会产生严重的健康和社会经济后果。我们旨在评估因急性呼吸道症状寻求医疗服务的育龄妇女中结核病的患病率及预测因素。
方法
2019年7月至2020年12月期间，我们在埃塞俄比亚的四家医疗机构连续纳入了因急性呼吸道症状寻求治疗的门诊育龄妇女。使用经过培训的护士管理的结构化问卷收集社会人口学特征和临床信息数据。对未怀孕的育龄妇女进行后前位胸部X光检查，并由两名放射科医生独立解读。从所有患者中采集痰液样本，使用Xpert MTB/RIF和/或涂片显微镜检查法检测肺结核。采用二元逻辑回归确定细菌学确诊结核病病例的预测因素，将临床相关变量纳入最终的Firth多元惩罚逻辑回归模型。
结果
我们纳入了577名参与者，其中95名（16%）为孕妇，67名（12%）感染艾滋病毒，512名（89%）咳嗽时间少于2周，56名（12%）胸部X光检查结果提示患有结核病。结核病的总体患病率为3%（95%置信区间：1.8%-4.7%），按咳嗽持续时间或艾滋病毒血清学状态分类的患者组之间未观察到显著差异（P = 0.9999）。在多变量分析中，提示结核病的胸部X光异常（调整后比值比18.83 [95%置信区间，6.20-57.18]）和体重减轻史（调整后比值比3.91 [95%置信区间，1.25-12.29]）与细菌学确诊的结核病病例相关。
结论
我们发现，急性呼吸道症状的低风险育龄妇女中结核病患病率很高。常规胸部X光检查可能会改善早期病例检测，从而改善结核病治疗结果。
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