Aluoch J A, Swai O B, Edwards E A, Stott H, Darbyshire J H, Fox W, Stephens R J
Tubercle. 1985 Dec;66(4):237-49. doi: 10.1016/0041-3879(85)90061-3.
This investigation is the sixth in a series of case-finding studies in Kenya. It explores the potential for case-finding by the identification of tuberculosis suspects (individuals with a cough for 1 month or more) through careful screening of general outpatients attending 4 district hospitals for the first time. Of 2299 suspects identified among 87 845 new outpatients attending the hospitals, 4.7% had culture-positive pulmonary tuberculosis, 3.6% having sputum positive on smear as well. In the 3 hospitals with radiographic facilities, 1.3% of suspects (whose sputum was negative on culture) were considered on review of their clinical history and chest radiograph by an independent assessor to have radiographically active tuberculous lesions and a further 2.5% to have inactive lesions. The proportion of bacteriologically positive cases per 1000 of the general population aged 6 years or more decreased as the distance of their homes from the hospital increased (P less than 0.001 for the trend). However, the proportion of cases per 1000 of the suspects identified increased as the distance of their homes from the hospital increased (P less than 0.001 for the trend). History of cough for between 1 and 12 months was the most useful factor for the identification of cases of tuberculosis among the suspects, and would have identified 92% of the smear-positive cases from the examination of 70% of the suspects; a history of weight loss identified 84% of the smear-positive cases from the examination of 64% of the suspects. A history of weight loss and/or a history of cough for between 1 and 12 months would have detected all the smear-positive cases from the examination of 89% of the suspects. The proportion of bacteriologically positive cases in the younger suspects aged 9-32 years (who had been eligible for a mass BCG campaign) was greater among the non-vaccinated than among the vaccinated suspects, 4.9% and 2.3% respectively (P=0.04), implying protection from vaccination of the order of 50%.
这项调查是在肯尼亚开展的一系列病例发现研究中的第六项。它通过对首次前往4家区级医院就诊的普通门诊患者进行仔细筛查，探索通过识别结核病疑似患者（咳嗽1个月及以上的个体）来发现病例的可能性。在前往医院就诊的87845名新门诊患者中识别出的2299名疑似患者中，4.7%患有培养阳性的肺结核，其中3.6%痰涂片也呈阳性。在具备影像学检查设施的3家医院中，独立评估人员在复查临床病史和胸部X光片后，认为1.3%的疑似患者（其痰培养为阴性）有影像学上活动性结核病变，另有2.5%有非活动性病变。每1000名6岁及以上普通人群中细菌学阳性病例的比例随着其住所与医院距离的增加而降低（趋势P<0.001）。然而，每1000名识别出的疑似患者中的病例比例随着其住所与医院距离的增加而增加（趋势P<0.001）。咳嗽1至12个月的病史是在疑似患者中识别结核病病例最有用的因素，通过检查70%的疑似患者可识别出92%的涂片阳性病例；体重减轻史通过检查64%的疑似患者可识别出84%的涂片阳性病例。体重减轻史和/或咳嗽1至12个月的病史通过检查89%的疑似患者可检测出所有涂片阳性病例。在9至32岁的年轻疑似患者（符合大规模卡介苗接种条件）中，未接种疫苗者的细菌学阳性病例比例高于接种疫苗者，分别为4.9%和2.3%（P=0.04），这意味着疫苗接种的保护率约为50%。
