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背景:博茨瓦纳的弗朗西斯敦和哈博罗内。目的:对于寻求异烟肼预防性治疗(IPT)的无症状HIV感染者(PLWH),使用X线胸片筛查是否患有肺结核(TB)。我们描述了在结核病流行地区HIV感染者的X线胸片影像特征,并且识别与TB有关的特征。设计:2004—2006年的一项关于无症状HIV感染者进行IPT(isoniazid preventive therapy)的临床试验,患者行X线胸片检查(CXRs),并且用标准化的X线胸片阅读以及记录系统(CRRS)进行了阅读。将影像结果与患者包括结核病相关情况在内的临床特征进行比较。结果:2732张筛查X线胸片中,用CRRS对183张有1个或以上异常的X线胸片进行了评分,其中42%有渗出性病变(36%在上叶),35%实质纤维化,32%淋巴结肿大。129(70%)例HIV感染者中有22例(17%)明确患有结核病。结核病与上叶渗出性病变(相对危险度relativerist[RR]3.0,95%可信区间1.5～6.2)和纵隔淋巴结肿大(相对危险度RR3.9,95%可信区间1.8～8.4)有关。上叶渗出性病变或纵隔淋巴结肿大对于TB诊断的敏感性和特异性分别为64%和82%。结论:综合X线胸片特点在预测无症状HIV感染者(PLWH)是否患结核病方面是有帮助的。CRRS应该更多的应用于类似的研究中。
Background: Francistown and Gaborone, Botswana. PURPOSE: To screen asymptomatic HIV-infected individuals (PLWH) for prophylactic treatment with isoniazid (IPT) using an X-ray to screen for tuberculosis (TB). We describe the X-ray images of HIV-infected people in endemic areas of tuberculosis and identify TB-related features. Design: A 2004-2006 clinical trial of patients with asymptomatic HIV infection undergoing IPT (isoniazid preventive therapy) underwent X-ray chest radiography (CXRs) and performed with a standardized X-ray reading and recording system ( CRRS) was read. The imaging findings were compared with those of patients with tuberculosis-related conditions. Results: Of 2732 screening radiographs, 183 with one or more abnormal chest radiographs were scored by CRRS, of which 42% had exudative lesions (36% in the upper lobe), 35% Real fibrosis, 32% of lymph nodes. Twenty-two (17%) of 129 (70%) cases of HIV-infected people were clearly affected with tuberculosis. Tuberculosis was associated with upper exudative lesions (relativerist [RR] 3.0, 95% confidence interval 1.5 to 6.2) and mediastinal lymph node enlargement (relative risk RR 3.9, 95% confidence interval 1.8 to 8.4) . The sensitivity and specificity of upper exudative or mediastinal lymph nodes for diagnosis of TB were 64% and 82%, respectively. CONCLUSIONS: The combined features of X-ray findings are helpful in predicting whether tuberculosis is at risk for asymptomatic HIV-infected individuals (PLWH). CRRS should be more used in similar studies.