Barmankulova Aigul, Higuchi Michiyo, Sarker Mohammad Abul Bashar, Alim Md Abdul, Hamajima Nobuyuki
Republican Center for Informatics and Epidemiology, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan ; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2015 Feb;77(1-2):41-9.
This cross-sectional study aimed to describe suspected tuberculosis (TB) cases among migrants in Kyrgyzstan and to estimate the accuracy of Xpert MTB/RIF, which has been operated in Kyrgyzstan since 2012. Characteristics of 3,714 suspected cases among migrants were analysed. In addition, by using data of 300 cases with culture results, sensitivity and specificity of Xpert MTB/RIF, both for detection of TB and rifampicin susceptibility, were assessed. Among 3,714 suspected cases, 56.1% were male, and the median age was 35 years old. Of the suspected cases, 17.2% were previously-treated. In total, 809 (21.8%) were smear-positive; 36.8% among previously-treated cases and 18.7% among new cases. Among 300 selected participants, 235 (78.3%) were culture-positive. Of those who were confirmed as TB positive, recurrent cases showed a higher proportion of rifampicin resistance than new cases (59.3% vs 42.6%). For detection of TB, the sensitivity and specificity of XpertMTB/RIF (81.3% and 98.2%) were higher than those of microscopy (70.2% and 71.4%). Sensitivity and specificity for detection of rifampicin resistance were 96.8% and 91.8%, respectively. The rifampicin resistance rate in the study population was higher than the national average. Xpert MTB/RIF showed higher accuracy in detecting TB cases than microscopic diagnosis. Higher accuracy and earlier detection of drug susceptibility is especially important for those who have difficulty in accessing healthcare and those who are easily lost from tracking, including migrants.
这项横断面研究旨在描述吉尔吉斯斯坦移民中的疑似结核病病例，并评估自2012年起在吉尔吉斯斯坦开展的Xpert MTB/RIF检测的准确性。分析了3714例移民疑似病例的特征。此外，利用300例有培养结果病例的数据，评估了Xpert MTB/RIF在结核病检测和利福平药敏检测方面的敏感性和特异性。在3714例疑似病例中，56.1%为男性，中位年龄为35岁。在疑似病例中，17.2%曾接受过治疗。共有809例（21.8%）涂片阳性；既往治疗病例中涂片阳性率为36.8%，新病例中为18.7%。在300名选定参与者中，235例（78.3%）培养阳性。在确诊为结核病阳性的患者中，复发病例的利福平耐药比例高于新病例（59.3%对42.6%）。对于结核病检测，Xpert MTB/RIF的敏感性和特异性（81.3%和98.2%）高于显微镜检查（70.2%和71.4%）。利福平耐药检测的敏感性和特异性分别为96.8%和91.8%。研究人群中的利福平耐药率高于全国平均水平。Xpert MTB/RIF在检测结核病病例方面比显微镜诊断具有更高的准确性。对于那些难以获得医疗服务以及容易失访的人群，包括移民，更高的准确性和更早的药敏检测尤为重要。
