Performance of Serum C-Reactive Protein as a Screening Test for Smear-Negative Tuberculosis in an Ambulatory High HIV Prevalence Population 英文参考文献.docVIP

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Performance of Serum C-Reactive Protein as a Screening Test for Smear-Negative Tuberculosis in an Ambulatory High HIV Prevalence Population 英文参考文献.doc

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Performance of Serum C-Reactive Protein as a Screening Test for Smear-Negative Tuberculosis in an Ambulatory High HIV Prevalence Population 英文参考文献

PerformanceofSerumC-ReactiveProteinasaScreening TestforSmear-NegativeTuberculosisinanAmbulatory HighHIVPrevalencePopulation DouglasWilson1*,MotasimBadri2,GaryMaartens3 1DepartmentofMedicine,EdendaleHospital,Pietermaritzburg,UniversityofKwaZulu-Natal,KwaZulu-Natal,SouthAfrica,2DepartmentofMedicine,UniversityofCape Town,CapeTown,SouthAfrica,3DivisionofClinicalPharmacology,DepartmentofMedicine,UniversityofCapeTown,CapeTown,SouthAfrica Abstract Background:Delayeddiagnosishascontributedtothehighmortalityofsputumsmear-negativetuberculosis(SNTB)inhigh HIVprevalencecountries.NewdiagnosticstrategiesforSNTBareurgentlyneeded.C-reactiveprotein(CRP)isanon-specific inflammatoryproteinthatisusuallyelevatedinpatientswithtuberculosis,butitsroleinthediagnosisoftuberculosisis uncertain. Methodology/PrincipalFindings:TodeterminethediagnosticutilityofCRPweprospectivelyevaluatedtheperformanceof CRPasascreeningtestforSNTBinsymptomaticambulatorytuberculosissuspectsfollowedupfor8weeksinKwaZulu- Natal, South Africa. Confirmed tuberculosis was defined as positive culture or acid-fast bacilli with granulomata on histology,andpossibletuberculosisasdocumentedresponsetoantituberculartherapy.TheCRPquotientwasdefinedasa multiple of the upper limit of normal of the serum CRP result. Three hundred and sixty four participants fulfilled entry criteria:135(37%)withconfirmedtuberculosis,114(39%)withpossibletuberculosis,and115(24%)withouttuberculosis. ThemedianCRPquotientwas15.4(IQR7.2;23.3)intheconfirmedtuberculosisgroup,5.8(IQR1.4;16.0)inthegroupwith possibletuberculosis,and0.7(IQR0.2;2.2)inthegroupwithouttuberculosis(p,0.0001).TheCRPquotientabovetheupper limitofnormalhadsensitivity0.98(95%CI0.94;0.99),specificity0.59(95%CI0.50;0.68),positivepredictivevalue0.74(95% CI0.67;0.80),negativepredictivevalue0.96(95%CI0.88;0.99),anddiagnosticoddsratio63.7(95%CI19.1;212.0)inthe confirmedtuberculosisgroupcomparedwiththegroupwithouttuberculosis.HigherCRPquotientsimprovedspecificityat theexpenseofsensitivity. Sig