结核药物敏感性快速检测的影响：秘鲁利马的项目经验。
Impact of rapid drug susceptibility testing for tuberculosis: program experience in Lima, Peru.
机构信息
Division of Global Health Equity, and Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
出版信息
Int J Tuberc Lung Dis. 2012 Nov;16(11):1538-43. doi: 10.5588/ijtld.12.0071. Epub 2012 Sep 14.
SETTING
Programmatic implementation of decentralized rapid drug susceptibility testing (DST) in Lima, Peru.
OBJECTIVE
Pre-post analysis compared time to diagnosis, treatment outcome and survival among patients tested with direct nitrate reductase assay (NRA) vs. indirect conventional methods.
DESIGN
From 2005 to 2009, we prospectively followed all patients referred for DST before (control) and after (intervention) NRA implementation. Among those referred for DST, NRA was used for smear-positive samples of patients with no prior history of multidrug resistance or treatment for multidrug-resistant tuberculosis (TB). Data were abstracted from patient charts and laboratory registers. Endpoints were favorable outcomes, time to result and time to death.
RESULTS
Of those patients who met the criteria for NRA, 740 underwent NRA and 621 underwent conventional DST. NRA yielded test results for 78.4% of cases vs. 68.8% for conventional DST (P < 0.0001); the median time to result was 44 vs. 133 days, respectively (adjusted HR 0.64, 95%CI 0.56-0.73). Among individuals without previous anti-tuberculosis treatment, NRA was associated with a favorable treatment outcome (adjusted OR 1.39, 95%CI 1.01-1.90) and prolonged survival (adjusted HR 0.53, 95%CI 0.31-0.90).
CONCLUSION
Direct NRA significantly shortened time to test result and improved treatment outcomes and survival in certain groups.
背景
在秘鲁利马实施去中心化快速药敏检测（DST）的项目式实施。
目的
直接硝酸还原酶检测（NRA）与间接传统方法检测的患者的诊断时间、治疗结果和生存情况进行前后对比分析。
设计
从 2005 年到 2009 年，我们前瞻性地随访了所有在直接 NRA 实施前（对照组）和后（干预组）进行 DST 检测的患者。对于那些需要进行 DST 检测的患者，如果没有多药耐药史或治疗过耐多药结核病（TB），NRA 用于涂片阳性的患者。数据从患者病历和实验室记录中提取。终点是良好的结果、获得结果的时间和死亡时间。
结果
在符合 NRA 标准的患者中，有 740 人接受了 NRA 检测，621 人接受了传统的 DST 检测。NRA 检测结果的阳性率为 78.4%，而传统 DST 检测的阳性率为 68.8%（P<0.0001）；结果中位数时间分别为 44 天和 133 天（校正 HR 0.64，95%CI 0.56-0.73）。在没有先前抗结核治疗的个体中，NRA 与良好的治疗结果（校正 OR 1.39，95%CI 1.01-1.90）和延长的生存时间（校正 HR 0.53，95%CI 0.31-0.90）相关。
结论
直接 NRA 显著缩短了检测结果的时间，改善了某些患者的治疗结果和生存情况。
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