Chandra T J, Selvaraj R, Sharma Y V
Department of Microbiology, GSL Medical College, Rajahmundry, India.
Centre for Laboratory Animal Technology and Research, Sathyabama University, Chennai, India.
Int J Tuberc Lung Dis. 2016 Feb;20(2):247-51. doi: 10.5588/ijtld.15.0566.
To evaluate the efficacy of sputum microscopy by the concentration method using spot and morning and same-day smears for the diagnosis of pulmonary tuberculosis.
Three sputum specimens (spot, second spot and morning) were collected from study participants. Three smears were prepared from the direct sample and three using the N-acetyl-l-cysteine-sodium hydroxide concentration method. The smears were stained using Ziehl-Neelsen (ZN) staining, modified ZN (MZN) staining and fluorescent staining (FS). Smear results were pooled and compared in two categories: standard spot and morning, and same-day smears. The χ(2) test was used to evaluate the statistical difference in smear-positive cases.
Among 3186 participants included in the study, smear positivity was respectively 9.6%, 9.8% and 10.8% for ZN, MZN and FS smears using spot and morning smears. Using same-day smears, smear positivity was respectively 9.5%, 9.8% and 10.6% for ZN, MZN and FS smears. Smear positivity increased to 16% with the concentration method.
Nil dropouts and patient convenience are the added advantages of using same-day smears, and the concentration method improved smear positivity. Given these advantages, using same-day smears with the concentration method should be considered by the World Health Organization and India's Revised National Tuberculosis Control Programme.
评估采用即时痰、晨痰和当日痰涂片浓缩法进行痰涂片镜检对肺结核诊断的效果。
从研究参与者处采集三份痰标本（即时痰、第二份即时痰和晨痰）。直接标本制备三张涂片，另外三张采用N-乙酰-L-半胱氨酸-氢氧化钠浓缩法制备。涂片采用萋-尼（ZN）染色、改良萋-尼（MZN）染色和荧光染色（FS）。将涂片结果汇总并分为两类进行比较：标准即时痰和晨痰，以及当日痰涂片。采用χ²检验评估涂片阳性病例的统计学差异。
在纳入研究的3186名参与者中，采用即时痰和晨痰涂片时，ZN、MZN和FS涂片的阳性率分别为9.6%、9.8%和10.8%。采用当日痰涂片时，ZN、MZN和FS涂片的阳性率分别为9.5%、9.8%和10.6%。采用浓缩法后涂片阳性率增至16%。
无脱落病例以及方便患者是采用当日痰涂片的额外优势，且浓缩法提高了涂片阳性率。鉴于这些优势，世界卫生组织和印度修订的国家结核病控制规划应考虑采用当日痰涂片结合浓缩法。
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