Cattamanchi A, Davis J L, Worodria W, den Boon S, Yoo S, Matovu J, Kiidha J, Nankya F, Kyeyune R, Byanyima P, Andama A, Joloba M, Osmond D H, Hopewell P C, Huang L
Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, USA.
Int J Tuberc Lung Dis. 2009 Sep;13(9):1130-6.
Mulago Hospital, Kampala, Uganda.
To evaluate the diagnostic performance of fluorescence microscopy (FM) for diagnosing pulmonary tuberculosis (TB) in a high human immunodeficiency virus (HIV) prevalence setting.
Consecutive in-patients with cough for >2 weeks submitted two sputum specimens for smear microscopy. Smears were examined by conventional light microscopy (CM) and FM. The performance of the two methods was compared using mycobacterial culture as a reference standard.
A total of 426 patients (82% HIV-infected) were evaluated. FM identified 11% more smear-positive patients than CM (49% vs. 38%, P < 0.001). However, positive FM results were less likely than positive CM results to be confirmed by culture when smears were read as either 'scanty' (54% vs. 90%, P < 0.001) or 1+ (82% vs. 91%, P = 0.02). Compared to CM, the sensitivity of FM was higher (72% vs. 64%, P = 0.005), and the specificity lower (81% vs. 96%, P < 0.001). In receiver operating characteristic analysis, maximum area under the curve for FM was obtained at a threshold of >4 acid-fast bacilli/100 fields (sensitivity 68%, specificity 90%).
Although FM increases the sensitivity of sputum smear microscopy, additional data on FM specificity and on the clinical consequences associated with false-positive FM results are needed to guide implementation of this technology in high HIV prevalence settings.
乌干达坎帕拉市穆拉戈医院。
在人类免疫缺陷病毒（HIV）高流行地区评估荧光显微镜检查（FM）诊断肺结核（TB）的诊断性能。
连续纳入咳嗽超过2周的住院患者，提交两份痰标本进行涂片显微镜检查。涂片分别采用传统光学显微镜检查（CM）和FM检查。以分枝杆菌培养作为参考标准，比较两种方法的性能。
共评估了426例患者（82%感染HIV）。FM检测出的涂片阳性患者比CM多11%（49%对38%，P<0.001）。然而，当涂片读片结果为“稀少”（54%对90%，P<0.001）或1+（82%对91%，P=0.02）时，FM阳性结果经培养确认的可能性低于CM阳性结果。与CM相比，FM的敏感性较高（72%对64%，P=0.005），特异性较低（81%对96%，P<0.001）。在受试者工作特征分析中，FM在酸快速杆菌/100视野>4的阈值下获得最大曲线下面积（敏感性68%，特异性90%）。
虽然FM提高了痰涂片显微镜检查的敏感性，但在HIV高流行地区实施该技术还需要关于FM特异性以及与FM假阳性结果相关临床后果的更多数据。
