Computed tomography in predicting smear-negative pulmonary tuberculosis in AIDS patients  

作　　者：FENG Feng SHIYu-xin XIAGan-lin ZHUYing LU Hong-zhou ZHANG Zhi-yong 

机构地区：[1]Department of Radiology, Shanghai Public Health Clinic Center Affiliated to Fudan University, Shanghai 201508, China [2]Department of Infectious Diseases, Shanghai Public Health Clinic Center Affiliated to Fudan University, Shanghai 201508, China [3]Department of Radiology, Nantong Tumor Hospital Affiliated to Nantong University, Nantong, Jiangsu 226361, China [4]Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

出　　处：《Chinese Medical Journal》2013年第17期3228-3233,共6页中华医学杂志（英文版）

摘　　要：Background The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography （CT） and clinical findings in predicting smear- negative pulmonary tuberculosis in AIDS patients. Methods A total of 121 AIDS patients suspected of smear-negative pulmonary tuberculosis by clinical and radiographic findings were recruited. Pulmonary tuberculosis was diagnosed in 57 （47.1%） patients. The CT and clinical predictors were selected to diagnose AIDS-related pulmonary tuberculosis through univariate and multivariate Logistic analysis. Results Multivariate analysis showed that five variables, including weight loss, presence of miliary nodules, necrotic lymph node, Iobular consolidation, tree-in-bud sign, were independent predictors of pulmonary tuberculosis in AIDS patients. Predicted scores based on the five variables were used to identify pulmonary tuberculosis. If the predicted score of 3 was taken as the ideal cut-off point in the diagnosis of AIDS-related smear-negative pulmonary tuberculosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 81.2%, 80.0%, 85.2%, and 82.6%, respectively. Conclusion The prediction method based on five key factors of clinical and CT findings are useful in guiding the diagnosis of smear-negative pulmonary tuberculosis in AIDS patients.Background The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography （CT） and clinical findings in predicting smear- negative pulmonary tuberculosis in AIDS patients. Methods A total of 121 AIDS patients suspected of smear-negative pulmonary tuberculosis by clinical and radiographic findings were recruited. Pulmonary tuberculosis was diagnosed in 57 （47.1%） patients. The CT and clinical predictors were selected to diagnose AIDS-related pulmonary tuberculosis through univariate and multivariate Logistic analysis. Results Multivariate analysis showed that five variables, including weight loss, presence of miliary nodules, necrotic lymph node, Iobular consolidation, tree-in-bud sign, were independent predictors of pulmonary tuberculosis in AIDS patients. Predicted scores based on the five variables were used to identify pulmonary tuberculosis. If the predicted score of 3 was taken as the ideal cut-off point in the diagnosis of AIDS-related smear-negative pulmonary tuberculosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 81.2%, 80.0%, 85.2%, and 82.6%, respectively. Conclusion The prediction method based on five key factors of clinical and CT findings are useful in guiding the diagnosis of smear-negative pulmonary tuberculosis in AIDS patients.

关 键 词：smear-negative pulmonary tuberculosis computed tomography clinical findings AIDS 

分 类 号：R512.91[医药卫生—内科学] R816.4[医药卫生—临床医学]