■在过去的十年中,肺外形式的结核病(TB)的频率增加了。这些形式经常被漏诊。这项关于结核病流行病学概况修改的声明,引导我们反思结核菌素皮肤测试(TST)在主动结核病检测中的实用性。本研究旨在评估TST用于主动结核病检测的诊断准确性。
■这是病例对照,在突尼斯11个抗结核中心进行的多中心研究(2014年6月至11月)。这些病例为18至55岁的成年人,患有新诊断和确诊的结核病。对照没有结核病。填写了数据收集表,并对每个参与者进行了TST。使用受试者工作曲线(ROC)曲线和曲线下面积(AUC)估计TST的诊断准确性测量,以估计确定的截止点的灵敏度和特异性。
■总的来说,纳入1050名患者,由336例病例和714例对照组成。病例的平均年龄为38.3±11.8岁,对照组为33.6±11岁。病例中TST硬结的平均直径明显高于对照组(13.7mmvs.6.2mm;p=10-6)。AUC为0.789[95%CI:0.758-0.819;p=0.01],对应于该测试的中等辨别性能。TST的最有区别的截止值,与最佳敏感性(73.7%)和特异性(76.6%)相关的夫妇≥11mm,Youden指数为0.503。阳性预测值和阴性预测值分别为3.11%和99.52%,分别。
■TST可能是用于主动结核病检测的有用工具,在11mm的截止点具有中等的全局性能和公认的灵敏度和特异性。然而,由于其多重缺点,它不能被视为黄金标准测试。
UNASSIGNED: During the past decade, the frequency of extrapulmonary forms of tuberculosis (TB) has increased. These forms are often miss-diagnosed. This statement of the TB epidemiological profile modification, conduct us to reflect about the utility of the Tuberculin Skin Test (TST) in active TB detection. This study aimed to evaluate the diagnostic accuracy performance of the TST for active tuberculosis detection.
UNASSIGNED: This was a
case-control, multicenter study conducted in 11 anti-TB centers in Tunisia (June-November2014). The cases were adults aged between 18 and 55 years with newly diagnosed and confirmed tuberculosis. Controls were free from tuberculosis. A data collection sheet was filled out and a TST was performed for each participant.Diagnostic accuracy measures of TST were estimated using Receiver Operating Curve (ROC) curve and Area Under Curve (AUC) to estimate sensitivity and specificity of a determined cut-off point.
UNASSIGNED: Overall, 1050 patients were enrolled, composed of 336 cases and 714 controls. The mean age was 38.3±11.8 years for cases and 33.6±11 years for controls.The mean diameter of the TST induration was significantly higher among cases than controls (13.7mm vs.6.2mm; p=10 -6). AUC was 0.789 [95% CI: 0.758-0.819; p=0.01], corresponding to a moderate discriminating performance for this test. The most discriminative cut-off value of the TST, which was associated with the best sensitivity (73.7%) and specificity (76.6%) couple was ≥ 11 mm with a Youden index of 0.503. Positive and Negative predictive values were 3.11% and 99.52%, respectively.
UNASSIGNED: TST could be a useful tool used for active tuberculosis detection, with a moderate global performance and accepted sensitivity and specificity at the cut-off point of 11 mm. However, it cannot be considered as a gold standard test due to its multiple disadvantages.