Dept of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
Eur Respir J. 2011 Feb;37(2):376-83. doi: 10.1183/09031936.00007410. Epub 2010 Jun 1.
Sputum smears and culture conversion are frequently used to evaluate treatment response in pulmonary tuberculosis patients. Limited data are available on the evaluation of the correlation between under-treatment sputum smear results and culture conversion. This prospective study included sputum culture-proven pulmonary tuberculosis patients at six hospitals in Taiwan. At least two sets of sputum were collected at the completion of 8 weeks of TB treatment. The sensitivities and specificities of 2-month sputum smears were estimated based on culture conversion status. A total of 371 patients were enrolled for analysis. Factors associated with culture conversion included having a smear positive before treatment, presence of a cavity on radiography, rifampicin resistance and usage of the DOTS (directly observed therapy, short course) strategy. The sensitivities of 2-month sputum smears for culture conversion among all patients, initially smear-positive patients and initially smear-negative patients were 64.3, 71.4 and 38%, respectively, and the specificities were 81.6, 69.9 and 92.8%, respectively. In patients who were 2-month sputum smear-positive, the 2-month culture conversion rate was 80% if the patients were under DOTS and without cavitary lesions in radiograms. The predictive value of 2-month sputum smears in culture conversion was limited and highly influenced by clinical factors in pulmonary tuberculosis patients.
痰涂片和培养转换常用于评估肺结核患者的治疗反应。关于治疗不足的痰涂片结果与培养转换之间相关性的评估，相关数据有限。本前瞻性研究纳入了台湾六家医院经痰培养证实的肺结核患者。在完成 8 周的结核病治疗后，至少收集两组痰标本。根据培养转换状态，估计 2 个月痰涂片的敏感性和特异性。共纳入 371 例患者进行分析。与培养转换相关的因素包括治疗前涂片阳性、影像学有空洞、利福平耐药和使用 DOTS（直接观察治疗、短程）策略。所有患者、初始涂片阳性患者和初始涂片阴性患者的 2 个月痰涂片对培养转换的敏感性分别为 64.3%、71.4%和 38%，特异性分别为 81.6%、69.9%和 92.8%。在 2 个月痰涂片阳性的患者中，如果患者接受 DOTS 治疗且影像学无空洞病变，则 2 个月的培养转换率为 80%。2 个月痰涂片在培养转换中的预测价值有限，并且在肺结核患者中受到临床因素的高度影响。
