South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Eur J Clin Microbiol Infect Dis. 2012 Apr;31(4):529-37. doi: 10.1007/s10096-011-1344-5. Epub 2011 Jul 28.
Sputum induction by the inhalation of hypertonic saline may increase the yield of microbiological diagnosis of pulmonary tuberculosis (TB). This is particularly relevant in paucibacillary TB, such as in children or human immunodeficiency virus (HIV)-infected patients. Sputum induction must be shown to be safe and tolerable in community settings where invasive diagnostic methods are unavailable. The objective of this study was to describe the changes in physiological parameters and adverse events occurring during sputum induction in ambulatory adult and adolescent TB suspects recruited in community clinics. Sputum induction was performed in HIV-infected (n = 35) and HIV-uninfected (n = 67) TB suspects (n = 102). Oxygen saturation (%), blood pressure (mm Hg), heart rate (/minute), respiratory rate (/minute), and adverse events were monitored at baseline, continuously during the salbutamol pre-treatment and saline nebulization phases, and for 30 min afterwards. During nebulization, there was a statistically significant increase in oxygen saturation (1%, p < 0.0001), systolic BP (7 mm Hg, p < 0.0001), and diastolic BP (2 mm Hg, p = 0.008). Post-nebulization decrease in the systolic BP occurred (4 mm Hg, p = 0.016). These changes were not considered to be clinically significant. Eight minor, transitory, self-resolving adverse events occurred (labored breathing, n = 2; chest pain, n = 2; paroxysmal coughing, n = 1; elevated heart rate, n = 1; vomiting, n = 1; hypotension, n = 1), leading to procedure termination in four participants. No serious adverse events occurred. Induced sputum is safe, tolerable, and feasible in adult and adolescent TB suspects in a community healthcare setting.
吸入高渗盐水诱导痰液可以提高肺结核（TB）微生物诊断的产量。这在细菌量较少的 TB 中尤为重要，例如儿童或人类免疫缺陷病毒（HIV）感染患者。在无法使用有创诊断方法的社区环境中，必须证明诱导痰液是安全且可耐受的。本研究的目的是描述在社区诊所招募的门诊成年和青少年疑似结核病患者中，诱导痰液时生理参数的变化和发生的不良事件。在 HIV 感染（n=35）和 HIV 未感染（n=67）的疑似结核病患者（n=102）中进行了痰液诱导。在基线时、沙丁胺醇预处理和盐水雾化阶段连续监测血氧饱和度（%）、血压（mmHg）、心率（/分钟）、呼吸频率（/分钟）和不良事件，并在之后 30 分钟监测。在雾化过程中，血氧饱和度（1%，p<0.0001）、收缩压（7mmHg，p<0.0001）和舒张压（2mmHg，p=0.008）均有统计学显著增加。雾化后收缩压下降（4mmHg，p=0.016）。这些变化被认为没有临床意义。发生了 8 例轻微、短暂、自行缓解的不良事件（呼吸困难，n=2；胸痛，n=2；阵发性咳嗽，n=1；心率升高，n=1；呕吐，n=1；低血压，n=1），导致 4 名参与者终止了该程序。没有发生严重不良事件。在社区医疗保健环境中，诱导痰液在成年和青少年疑似结核病患者中是安全、耐受和可行的。
