Styblo K, van Geuns H A, Meijer J
Tubercle. 1984 Dec;65(4):237-51. doi: 10.1016/0041-3879(84)90034-5.
The aim of the study was to elucidate the yield of annual chest X-ray and bacteriological examination in subjects with inactive tuberculosis or fibrotic lesions. Nearly 15 000 such persons registered at the Tuberculosis Clinics (C.B.s.) in Amsterdam, Rotterdam and Utrecht were allocated at random to either the Check-up group or the Discharge group: every person had an initial chest X-ray and examination of sputum or tracheal lavage for tubercle bacilli. Those in the Check-up group were re-examined annually for 3 years, while those in the Discharge group were not, but were encouraged to come to the C.B. if they developed symptoms suggestive of tuberculosis. Every patient was invited, after 3 years, to attend for a final follow-up examination. Nearly 90% of patients in the Check-up group attended for annual examination. Twenty-eight reactivations were reported during the 3 years, 23 pulmonary and 5 non-respiratory. They occurred in 12 patients previously treated by chemotherapy (1.2 per 1000 per year), in 15 with inactive tuberculosis (1.5 per 1000 per year) and in one with a fibrotic lesion (0.3 per 1000). Tubercle bacilli were found by smear and culture in only 2 cases and by culture only in 24. In the majority of reactivations only a small number of colonies were isolated on culture and no deterioration on the X-ray was seen. In the discharge group, 917 persons reported to the C.B.s because of pulmonary symptoms; 12 reactivations were found during the 3 years: 10 of the patients had received previous chemotherapy. Only 2 patients were positive at microscopy and in the majority of culture-positive cases a small number of colonies were isolated; 5 of the 9 patients with pulmonary tuberculosis showed deterioration in the X-ray appearance. At the final re-examination in the fourth year, similar numbers of cases were found in the Check-up group (14) and Discharge group (15). However, there were less smear-positive cases in the Check-up group and less cases with X-ray deterioration. There were 69 confirmed reactivations in all. The annual rate of reactivation was 1.6 per 1000 in the Check-up group and 1.1 per 1000 in the Discharge group. It is suggested that routine annual check-ups of patients with inactive tuberculosis or fibrotic lesions should be discontinued.
本研究的目的是阐明年度胸部X光检查和细菌学检查在非活动性肺结核或纤维化病变患者中的效果。在阿姆斯特丹、鹿特丹和乌得勒支的结核病诊所（C.B.s.）登记的近15000名此类患者被随机分配到检查组或出院组：每个人都进行了初始胸部X光检查以及痰液或气管灌洗的结核杆菌检查。检查组的患者每年复查3年，而出院组的患者则不进行复查，但如果出现提示结核病的症状，会被鼓励前往C.B.。3年后，每位患者都被邀请参加最终的随访检查。检查组近90%的患者参加了年度检查。3年期间报告了28例复发，23例为肺部复发，5例为非呼吸道复发。它们发生在12例先前接受化疗的患者中（每年每1000人中有1.2例），15例非活动性肺结核患者中（每年每1000人中有1.5例）以及1例纤维化病变患者中（每年每1000人中有0.3例）。仅2例通过涂片和培养发现结核杆菌，24例仅通过培养发现。在大多数复发病例中，培养仅分离出少量菌落，X光检查未见恶化。在出院组中，917人因肺部症状前往C.B.s.；3年期间发现12例复发：其中10例患者先前接受过化疗。仅2例患者显微镜检查呈阳性，在大多数培养阳性病例中分离出少量菌落；9例肺结核患者中有5例X光表现恶化。在第四年的最终复查中，检查组（14例）和出院组（15例）发现的病例数相似。然而，检查组涂片阳性病例较少，X光恶化病例也较少。总共确诊69例复发。检查组的年复发率为每1000人中有1.6例，出院组为每1000人中有1.1例。建议停止对非活动性肺结核或纤维化病变患者进行常规年度检查。
