對於結核菌素反應陽性的患者,採用CXR篩查無效

不具有成本效益;消耗資源;增加放射暴露

  2002年5月24日─在5月19日的美國胸部協會年會上宣讀的一篇研究的結果顯示,對無症狀,也就是說低危險的,結核菌素反應陽性的患者,定期進行胸部X光篩檢,不具有成本效益。

  美國伯明罕阿拉巴馬大學的J. Aristizabal醫師及其同事寫道:「未經治療的、結核菌素皮膚反應(tuberculin skin test,TST)陽性者,對於每年CXR檢查的需要問題,州與當地的政策之間,非常缺少一致性。」每年的CXR檢查很昂貴,在此削減醫療費用之際,每年檢查的價值,需要重新評估。

  此次對於醫療記錄的回顧性研究中,有286位患者符合入選標準,TST反應陽性,未進行化學藥物預防以及在1991年6月至2001年6月期間,最少在Jefferson社區衛生部門進行了三次定期的CXR檢查。

  由於只發現一位患者通過定期的CXR檢查發現有早期的活動性病變,因此作者在95%的可信度下,得出結論說, 進行定期CXR檢查的患者中,只有1.65%或者更少的患者發現患有活動性肺結核(TB)。在低危險度的患者中,實際檢出率可能更低,因為這位患者還有其他的危險因素。他最近與一位活動性肺結核患者接觸,發現他同時有IV度的藥物濫用,這使他的危險要比那些一般人群的個體更高。

   「我們得到這樣的結論,對於TST陽性的患者,進行定期CXR檢查以在一般人群中早期檢出活動性肺結核,不具有成本效益,」作者寫道:「另外,這種做法消耗資源,而且還使患者增加不必要的放射線暴露。」

CXR Ineffective Screen in Tuberculin-Positive Patients

Not Cost-Effective; Consumes Resources; Increases Radiation Exposure

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

May 24, 2002 -- Periodic chest x-rays (CXR) are not cost-effective in screening asymptomatic, otherwise low-risk patients who are tuberculin positive, according to research presented on May 19 at the American Thoracic Society annual meeting.

"There is a considerable lack of uniformity in state and local policy regarding the need for annual CXR evaluation in individuals who have an untreated positive tuberculin skin test (TST)," write J. Aristizabal, MD, from the University of Alabama at Birmingham, and colleagues. Annual CXRs are costly and in this time of cost cutting, the value of annual testing needs to be re-evaluated."

In this retrospective medical record review, 286 patients met entry criteria of a positive TST, no chemoprophylaxis, and at least three periodic CXRs at the Jefferson County Health Department from June 1991 through June 2001.

Since there was only 1 patient found to have early active disease on periodic CXR, the authors conclude with 95% confidence that 1.65% or fewer of all patients having periodic CXR are found to have active pulmonary tuberculosis (TB). The actual detection rate in low-risk patients may be lower, because this individual had other risk factors. His recent contact with an active TB case and IV drug abuse put him at higher risk than individuals in the general population.

"We conclude that periodic CXRs in people who are TST positive are not cost-effective for early detection of active pulmonary TB in the general population," the authors write. "Additionally, it is resource consuming and results in unnecessary radiation exposure for the patient."

© 2002 WebMD Inc. All rights reserved.

    
相關報導
與風濕性關節炎藥物相關的結核病被檢驗出
2001/8/21

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