Mase S R, Ramsay A, Ng V, Henry M, Hopewell P C, Cunningham J, Urbanczik R, Perkins M D, Aziz M A, Pai M
Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA.
Int J Tuberc Lung Dis. 2007 May;11(5):485-95.
Current international tuberculosis (TB) guidelines recommend the microscopic examination of three sputum specimens for acid-fast bacilli in the evaluation of persons suspected of having pulmonary TB. We conducted a systematic review of studies that quantified the diagnostic yield of each of three sputum specimens. By searching multiple databases and sources, we identified a total of 37 eligible studies. The incremental yield in smear-positive results (in studies using all smear-positive cases as the denominator) and the increase in sensitivity (in studies that used all culture-positive cases as the denominator) of the third specimen were the main outcomes of interest. Although heterogeneity in study methods and results presented challenges for data synthesis, subgroup analyses suggest that the average incremental yield and/or the increase in sensitivity of examining a third specimen ranged between 2% and 5%. Reducing the recommended number of specimens examined from three to two (particularly to two specimens collected on the same day) could benefit TB control programs, and potentially increase case detection for several reasons. A number of operational research issues need to be addressed. Studies examining the most effective and efficient means to utilize current technologies for microscopic examination of sputum would be most useful if they followed an internationally coordinated and standardized approach, both to strengthen the country-specific evidence base and to permit comparison among studies.
当前国际结核病指南建议，在对疑似肺结核患者进行评估时，对三份痰标本进行抗酸杆菌显微镜检查。我们对量化三份痰标本中每份标本诊断检出率的研究进行了系统评价。通过检索多个数据库和来源，我们共确定了37项符合条件的研究。主要关注的结果是第三份标本涂片阳性结果的增量检出率（在以所有涂片阳性病例为分母的研究中）和敏感性的提高（在以所有培养阳性病例为分母的研究中）。尽管研究方法和结果的异质性给数据合成带来了挑战，但亚组分析表明，检查第三份标本的平均增量检出率和/或敏感性提高在2%至5%之间。将推荐检查的标本数量从三份减少到两份（特别是同一天采集的两份标本）可能会使结核病控制项目受益，并可能因多种原因增加病例发现。需要解决一些运筹学问题。如果采用国际协调和标准化的方法，研究利用当前痰显微镜检查技术的最有效和高效手段将最为有用，这既能加强各国的证据基础，又能使研究之间进行比较。
