预先加载痰涂片显微镜检查能否作为活动性肺结核病例发现的一种选择？

Is frontloaded sputum microscopy an option in active tuberculosis case finding?

作者信息

Lorent N, Buyze J, Kim T, Kong C, Van Deun A, Colebunders R, Thai S, Lynen L, Rigouts L

机构信息

Infectious Diseases Department, Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia; Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium.

Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium.

出版信息

Int J Tuberc Lung Dis. 2015 Jan;19(1):91-6. doi: 10.5588/ijtld.14.0388.

DOI:10.5588/ijtld.14.0388

PMID:25519797

Abstract

SETTING

Active tuberculosis (TB) case finding (ACF) in Phnom Penh, Cambodia using light-emitting diode fluorescence microscopy (FM).

OBJECTIVE

To evaluate the smear-positive yield of frontloaded (same-day) smear microscopy in ACF.

DESIGN

All presumptive TB cases screened through ACF were asked to provide three sputum specimens: two spot specimens on Day 1 and a morning specimen on Day 2 (spot-spot-morning, SSM). Laboratory technicians blinded to previous results read the smears using FM. We considered only SSM series with at least one positive smear to calculate the proportion of TB cases missed and to determine the difference between the spot-spot (SS) and spot-morning (SM) approach.

RESULTS

Of 4616 presumptive TB patients enrolled, 3306 provided three sputum samples. Of 2957 (89.4%) who followed the SSM approach, 188 (6.4%) were smear-positive: 177 on SM and 160 on SS. The incremental yield of the second sputum sample was 18.1% for SM vs. 9.4% for SS. Relative to any smear-positive case detected by SSM, 28/188 (14.9%, 95%CI 10.1-20.8) TB cases would be missed by SS vs. 11/188 (5.9%, 95%CI 3.0-10.2) by SM. The difference in the proportion of missed TB patients was 9.0% (P = 0.006).

CONCLUSION

ACF frontloaded sputum microscopy is inferior in terms of smear-positive yield: the SS approach would have missed a significant proportion of smear-positive TB.

摘要

背景

在柬埔寨金边采用发光二极管荧光显微镜检查（FM）开展活动性肺结核（TB）病例发现（ACF）工作。

目的

评估ACF中当日涂片显微镜检查的涂片阳性检出率。

设计

所有通过ACF筛查的疑似TB病例均被要求提供三份痰标本：第1天的两份即时痰标本和第2天的一份晨痰标本（即时痰-即时痰-晨痰，SSM）。对先前结果不知情的实验室技术人员使用FM对涂片进行阅片。我们仅考虑至少有一次涂片阳性的SSM系列，以计算漏诊的TB病例比例，并确定即时痰-即时痰（SS）和即时痰-晨痰（SM）方法之间的差异。

结果

在纳入的4616例疑似TB患者中，3306例提供了三份痰标本。在遵循SSM方法的2957例（89.4%）患者中，188例（6.4%）涂片阳性：SM法检出177例，SS法检出160例。SM法第二份痰标本的增量检出率为18.1%，而SS法为9.4%。相对于SSM法检测到的任何涂片阳性病例，SS法会漏诊28/188（14.9%，95%CI 10.1-20.8）例TB病例，而SM法为11/188（5.9%，95%CI 3.0-10.2）例。漏诊TB患者比例的差异为9.0%（P = 0.006）。