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結核罹患率の高い国では、日常的な胸部X線検査は必要か？
Is routine pre-entry chest radiograph necessary in a high tuberculosis prevalence country?
PMID: 32270779 PMCID: PMC7239409. DOI: 10.4103/jpgm.JPGM_462_19.
抄録
文脈:
胸部X線写真は、就職前や研修前のスクリーニングツールとして、様々な医療機関やその他の政府・非政府機関で世界中で利用されている。過去に行われた多くの研究では、結核検出の歩留まりが比較的低いことが示されており、著者らはこの慣行に疑問を呈している。
Context: Chest radiographs have been used worldwide as a screening tool before employment and training, by various healthcare and other government and nongovernment institutions. Many studies done in the past have demonstrated a relatively low yield for tuberculosis detection and therefore, the authors have questioned this practice.
目的:
医療現場に曝露したことのある人（曝露後群）と曝露していない人（曝露前群）の2つの群で、曝露前・入職前胸部X線検査の価値を比較し、この2つの群間で結核の検出に有意な差があるかどうかを判断する。
Aims: To compare the value of the preadmission/employment chest radiograph in two groups, namely, those who have been previously exposed to a healthcare setting (post-exposure group) and those who have not been exposed (pre-exposure group) and to determine if there is a significant difference in tuberculosis detection between these two groups.
設定とデザイン:
2014年から2017年の間に当院の各種学部・大学院コースに入学を希望して出頭した全受験者の胸部X線写真の報告書のレトロスペクティブレビューを行った。
Settings and Design: A retrospective review of the reports of the chest radiographs of all candidates appearing for admission to various undergraduate and postgraduate courses in our institute between 2014 and 2017 was performed.
材料と方法:
検出された各種異常を記録し、両群の所見を比較した。
Materials and Methods: The various abnormalities detected were recorded and the findings in the two groups were compared.
使用した統計解析:
2群間の比率を比較するためにカイ二乗検定を用いた。
Statistical Analysis Used: Chi-square test was used to compare between two group proportions.
結果:
肺実質、縦隔、心臓、胸膜の胸部X線検査では、被爆前群4333人中30人（0.69％）、被爆後群3379人中53人（1.57％）に肺実質、縦隔、心臓、胸膜に異常が認められた。被爆前群では、6人（0.14％）に基礎疾患のある心疾患、1人（0.02％）に結核が認められた。当院で検査を受けた被爆後群の6名のうち、5名（0.15％）が結核と診断された。結核の検出率には両群間で統計的に有意な差はなかったが（P = 0.051）、被爆後群では結核の検出率が高くなる傾向がみられた。
Results: Thirty out of 4333 (0.69%) candidates in the pre-exposure group and 53 out of 3379 (1.57%) candidates in the post-exposure group showed abnormalities on chest radiographs involving the lung parenchyma, mediastinum, heart, or pleura. In the pre-exposure group, six (0.14%) were found to have underlying cardiac disease and one (0.02%) had tuberculosis. Among the six candidates in the post-exposure group who underwent further investigations in our institute, five (0.15%) were diagnosed to have tuberculosis. Although there was no statistically significant difference in tuberculosis detection between the groups (P = 0.051), there is a trend towards higher detection of tuberculosis in the post-exposure group.
結論:
結核の有病率が高い国では、胸部X線検査は被爆後群でも結核を検出する役割を果たしている可能性がある。
Conclusions: In a country where the prevalence of tuberculosis is high, the pre-employment chest radiograph may still have a role in detecting tuberculosis in the post-exposure group.