Pulmonary and Critical Care Medicine Division, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA 94110, USA.
Lancet Infect Dis. 2013 Feb;13(2):147-54. doi: 10.1016/S1473-3099(12)70232-3. Epub 2012 Oct 23.
Sputum smear microscopy is the most widely available diagnostic test for pulmonary tuberculosis in countries with a high burden of the disease. Improving its accuracy is crucial to achievement of case-detection targets established by the Millennium Development Goals. Unfortunately, many patients are unable to submit all of the specimens needed for examination or to return for treatment because standard sputum collection and reporting requires several clinic visits. To inform policy recommendations by a WHO-convened Expert Group, we aimed to assess the accuracy of sputum smear examination with strategies for obtaining sputum on 1 day compared with strategies for obtaining sputum over 2 days.
We did a systematic review and meta-analysis of research articles comparing the accuracy of front-loaded or same-day microscopy and standard sputum smear microscopy for diagnosis of culture-confirmed pulmonary tuberculosis. We searched Medline, Embase, Biosis, and Web of Science for articles published between Jan 1, 2005, and Feb 14, 2012. Two investigators identified eligible articles and extracted data for individual study sites. We generated pooled summary estimates (95% CIs) for sensitivity and specificity by use of random-effects meta-analysis when four or more studies were available.
We identified eight relevant studies from five articles enrolling 7771 patients with suspected tuberculosis in low-income countries. Compared with the standard approach of examination of two smears with Ziehl-Neelsen light microscopy over 2 days, examination of two smears taken on the same day had much the same sensitivity (64% [95% CI 60 to 69] for standard microscopy vs 63% [58 to 68] for same-day microscopy) and specificity (98% [97 to 99] vs 98% [97 to 99]). We noted similar results for studies employing light-emitting diode fluorescence microscopy and for studies examining three smears, whether they were compared with two-smear strategies or with one another.
Same-day sputum smear microscopy is as accurate as standard smear microscopy. Data from tuberculosis programmes are needed to document the changes required in the health system to successfully implement the strategy and understand its effects.
WHO and US National Institutes of Health.
在结核病负担较高的国家，痰涂片显微镜检查是最广泛应用的诊断肺结核的检测方法。提高其准确性对于实现千年发展目标确立的病例检出目标至关重要。不幸的是，许多患者无法提交所有用于检查的标本，或者无法返回进行治疗，因为标准的痰标本采集和报告需要多次就诊。为了为世卫组织召集的专家组的政策建议提供信息，我们旨在评估在 1 天内获得痰标本的策略与在 2 天内获得痰标本的策略相比，对痰涂片镜检准确性的影响。
我们对比较了前负荷或当日显微镜检查与标准痰涂片显微镜检查对培养确诊的肺结核诊断准确性的研究进行了系统评价和荟萃分析。我们在 2005 年 1 月 1 日至 2012 年 2 月 14 日期间在 Medline、Embase、Biosis 和 Web of Science 中检索了文章。两位调查员确定了合格的文章，并提取了各研究地点的数据。当有 4 项或更多研究时，我们采用随机效应荟萃分析生成敏感性和特异性的汇总估计值（95%CI）。
我们从五项研究中的五篇文章中确定了八项符合条件的研究，共纳入了 7771 例疑似结核病患者，这些患者均来自低收入国家。与标准的在 2 天内检查 2 次痰标本、用齐-尼氏抗酸染色法进行显微镜检查的方法相比，同一天检查 2 次痰标本的方法具有相似的敏感性（标准显微镜检查为 64%[95%CI 60%至 69%]，当日显微镜检查为 63%[58%至 68%]）和特异性（98%[97%至 99%]）。我们注意到，对于使用发光二极管荧光显微镜的研究以及对于检查 3 次痰标本的研究，无论是与 2 次痰标本策略比较，还是相互比较，结果均相似。
当日痰涂片显微镜检查与标准涂片显微镜检查一样准确。需要从结核病规划中获取数据，以记录成功实施该策略所需的卫生系统的改变，并了解其效果。
世卫组织和美国国立卫生研究院。
