综合医院肺结核病诊断要素探讨

目的 :总结综合医院肺结核诊断的经验 ,探索在诸多临床和实验室诊断因素中哪些是重要因素。方法 :收集本院1999年临床疑诊为肺结核患者 30例 ,其中确诊为肺结核 16例 ,非肺结核 14例 ;记录每例患者的 15个病史特征因素和 14个实验室特征因素以及最终诊断。将以上资料作对数优势线性回归分析、单因素 χ2 分析和诊断筛查试验分析。结果 :多因素分析中发现 X线胸片上野淡薄云雾影最重要 ,痰菌涂片次之 ,发热第三 ;单因素分析中发现 X线和痰菌涂片仍有意义 ,而发热却没有临床意义 ;诊断筛查试验分析也说明 X线胸片的正确率最高 ,痰菌涂片次之 ,发热的正确率最低 ;在涂阳结核和涂阴结核之间 ,以上三因素无明显差别。结论 :在综合医院的肺结核诊断工作中 X线胸片的表现是重点 ,其次是痰菌涂片 ,而痰菌涂片的临床表现的特异性最差 ;在综合医院仍然需要开展结核杆菌的培养工作 ;在未来的工作中应建立适应我国国情的肺结核诊断评分系统 ,使肺结核的诊断由经验走向循证

Discussion on the Diagnostic Factors of Pulmonary Tuberculosis in a General Hospital

Objective: To summarize the experience for the diagnosis of pulmonary tuberculosis in general hospital and discuss which are more important in many clinical and laboratory factors. Methods: In 30 cases under suspicion of pulmonary tuberculosis 16 cases were ultimately diagnosed as pulmonary tuberculosis and 14 as non-tuberculosis in 1999. 15 medical history and symptom factors, 14 laboratory factors and final diagnosis were obtained. Logistic regression, univariate χ 2 test and the diagnostic and screening test were used for above data. Results: The most important, the second and the third factor are the chest radiograph with upper lobe infiltrate, the sputum smear for acid-fast bacilus(AFB) and the clinic fever respectively by logistic regression. By univariate χ 2 test the clinic fever has no significance. The diagnostic and screening test show the same results as logistic regression. Between the smear positive and negtive pulmonary tuberculosis there is no difference among forementioned free factors by χ 2 tset. Conclusion: The most important is the chest radiograph for diagnosing pulmonary tuberculosis in a general hospital, the second is the sputum smear for AFB and the lowest accurate rate is the clinical symptoms. It is still necessary to set up sputum culture in a general hospital. In order to accelerate the change from the experience-based to the evidence-based medical mode we suggest that an evaluating system of pulmonary tuberculosis diagnosis of our country be established as possible as quickly.