Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Trop Med Int Health. 2010 Dec;15(12):1475-80. doi: 10.1111/j.1365-3156.2010.02645.x.
To determine the efficiency of routine tuberculosis (TB) case detection by examining sputum smear positivity for acid-fast bacilli in relation to duration of cough, characteristics of TB suspects examined and health service factors.
We combined patient interviews with routine data from laboratory registers in 6 health care facilities in San Juan de Lurigancho district, Lima, Peru. A TB case was defined as a TB suspect with at least one positive sputum smear. We calculated adjusted odds ratios with 95% confidence intervals for the association between smear positivity and health service and patient's characteristics.
Smear positivity was 7.3% (321/4376). Of the 4376 adults submitting sputa, 55.3% (2418) reported cough for <14 days. In this group, smear microscopy yielded 3.2% (78/2418) positive results vs. 12.4% (243/1958) in patients coughing for 14 or more days. Having cough for >2 weeks, being referred by health care staff, attending a secondary-level health care facility, male sex and age between 15 and 44 years were independent determinants of smear positivity.
Routine case detection yields a low proportion of smear-positive cases because of the inclusion of a high proportion of patients without cough or coughing for <2 weeks. Adherence to the national TB control programme guidelines on the selection of TB suspects would have a positive impact on the smear positivity rate, reduce laboratory costs and workload and possibly improve the reading quality of smear microscopy.
确定通过检查痰涂片抗酸杆菌阳性率来发现常规结核病（TB）病例的效率，同时考虑咳嗽持续时间、被检查的 TB 可疑患者的特征以及卫生服务因素。
我们将患者访谈与秘鲁利马圣胡安德卢里甘乔区 6 家医疗保健机构的实验室登记处的常规数据相结合。将至少有一次痰涂片阳性的 TB 可疑患者定义为 TB 病例。我们计算了涂片阳性与卫生服务和患者特征之间关联的调整比值比及其 95%置信区间。
涂片阳性率为 7.3%（321/4376）。在 4376 名提交痰液的成年人中，55.3%（2418 人）报告咳嗽时间<14 天。在这一组中，痰显微镜检查阳性结果为 3.2%（78/2418），而咳嗽时间为 14 天或以上的患者阳性结果为 12.4%（243/1958）。咳嗽时间>2 周、由卫生保健人员转诊、到二级保健机构就诊、男性和年龄在 15 至 44 岁之间是涂片阳性的独立决定因素。
由于包括了很大比例没有咳嗽或咳嗽时间<2 周的患者，常规病例发现方法导致涂片阳性病例的比例较低。如果能遵守国家结核病控制规划指南中关于选择 TB 可疑患者的规定，将会对涂片阳性率产生积极影响，降低实验室成本和工作量，并可能提高涂片显微镜检查的质量。
