보건소 균음성 폐결핵 환자의 신고 정확도 연구
The diagnostic accuracy of notified new culture-negative pulmonary tuberculosis patients in public healthcare centers
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목적: 2000년 이래로 시행되고 있는 결핵정보 감시체계의 발생률 통계는 신고된 환자를 기준으로 하기 때문에 이로써 우리나라의 결핵 규모를 가늠하기 위해서는 자료의 타당성(validity)을 평가하는 것이 필요하다. 우리나라 공공 부분의 결핵관리는 1962년 이래 보건소를 중심으로 국가 결핵 관리의 중추적인 역할을 담당해 왔는데 본 연구자들은 보건소로부터 결핵정보 감시체계를 통해 폐결핵으로 신고된 환자 가운데 실제로 결핵이 아님에도 불구하고 결핵으로 과잉 진단된 환자의 규모가 어느 정도 되는지를 파악하고자 하였다. 방법: 연구자가 무작위로 방문한 전국 보건소에서 2005년 1월 1일부터 2005년 12월 31일까지 폐결핵 신환자로 신고된 환자들 중 객담 도말 및 배양검사 음성인 균 음성 환자들을 연구 대상으로 하였다. 증상이 있으면서 진단 당시 활동성 폐결핵의 방사선학적 소견이 있고 항결핵제 치료 후 방사선 병변이 호전된 환자는 ‘결핵 가능성이 높은 환자’(probable TB)로 분류하였고, 세 가지 소견을 모두 만족하지 못한 환자는 ‘결핵 가능성이 낮은 환자’(probably not TB)로 분류하였다. 결과: 총 263명의 환자들이 분석되었다. 신고된 폐결핵 신환들의 연령 중앙값은 41세였고, 이 중 60.8%가 남성이었다. ‘결핵 가능성이 높은 환자’는 79명으로서 전체 43.2% (95% CI, 39.6∼46.7%)이었고, 증상도 없고 방사선학적으로도 ‘결핵 가능성이 낮은 환자’는 9명으로서 전체의 4.9% (95% CI, 4.2∼5.6%)를 차지하였다. 결론: 결론적으로 보건소 균음성 폐결핵 신환자의 대다수는 실제 결핵의 가능성이 높았다. 그러나 일부의 과잉 진단의 가능성도 확인할 수 있었으며 신고자료의 정확성에 대한 평가가 향후 지속적으로 이루어져야 할 것이다.
Abstract
Background/Aims: The notification rate based on the Korean tuberculosis (TB) surveillance system has been widely used to evaluate the TB burden in Korea. However, few studies have examined the accuracy of TB diagnosis among notified cases. This study evaluated the diagnostic accuracy of microbiologically not proven cases notified as ‘new pulmonary TB patients’ at public healthcare centers. Methods: We reviewed the clinical symptoms and initial and follow-up chest radiographs of notified smear-and-culture- negative TB cases in randomly selected healthcare centers between Jan 2005 and Dec 2005. Patients who had symptoms, initial chest radiographs compatible with pulmonary TB, and radiological improvements after treatment were diagnosed as ‘probable TB’, while patients who did not meet these three criteria were diagnosed as ‘probably not TB’. Results: The analysis included 263 patients. The median age of the notified TB cases was 41 years, 60.8% of them were male, and 43.2% were ‘probable TB’ patients. Overall, 82.0% of the patients had either initial chest radiographs compatible with pulmonary TB or radiological improvements after treatment. Ultimately, 4.9% were ‘probably not TB’ patients. Conclusions: Most of the new notified pulmonary TB patients not confirmed microbiologically in public clinics can be considered real TB patients, although there are some over diagnosed cases.
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