在尼日利亚克罗斯河州结核病控制项目中采用Xpert MTB/Rif技术评估肺结核病例发现情况的改善

Evaluation of pulmonary tuberculosis case detection improvement with the deployment of XpertMTB/Rif in the tuberculosis control program of cross River State, Nigeria.

作者信息

Ochang Ernest Afu, Emanghe Ubleni E, Ewa Atana, Otu Akaninyene, Offor Jonah B, Odo Micheal, Etokidem Aniekan, Afirima Barinadaa, Owuna Oju Eni, Obeten Sunday M, Meremikwu Martin M

机构信息

Department of Medical Microbiology and Parasitology, University of Calabar, Calabar, Nigeria.

Department of Tuberculosis, Buruli and Leprosy Control Programme, Cross River State Ministry of Health, Calabar, Nigeria.

出版信息

Int J Mycobacteriol. 2017 Jan-Mar;6(1):94-96. doi: 10.4103/2212-5531.201890.

DOI:10.4103/2212-5531.201890

PMID:28317812

Abstract

OBJECTIVE/BACKGROUND: Global indices show that Nigeria has the highest tuberculosis (TB)-related mortality rate. Overdependence on Ziehl-Neelsen (ZN) smear microscopy for diagnosis and human immunodeficiency virus (HIV)/AIDS has limited control efforts. The new polymerase chain reaction-based XpertMTB/Rif (Cepheid Inc., CA, USA), which detects Mycobacterium tuberculosis and rifampicin resistance, was introduced in Cross River State in 2014. We evaluated the increment in pulmonary TB case detection following introduction of XpertMTB/Rif into the Cross River State TB control program.

MATERIALS AND METHODS

Data from three XpertMTB/Rif centers in Cross River were prospectively collected from June 2014 to December 2015. One spot specimen and one early morning sputum specimen were collected from each patient and tested using microscopy while one specimen was used for XpertMTB/Rif.

RESULTS

A total of 2326 patients comprising 47.4.0% (1103) males and 52.6% (1223) females were evaluated. Their mean age was 38.8 years (range 4-89 years); 42.6% (991) were HIV positive and 50.9% (1183) HIV negative, and for 6.5% (158) HIV status was unknown. XpertMTB/Rif detected M. tuberculosis in 22.9% (534) of patients, while 16.8% (391) were ZN smear positive. Smear microscopy missed 24.5% (131/534) of cases (P < 0.0001). When patients where categorized according to HIV status, XpertMTB/Rif detected 23.7% (280/1183) and ZN smear microscopy detected 18.5% (219/1183) of HIV-negative patients. XpertMTB/Rif detected 21.5% (213/991) and ZN smear 14.1% (140/991) of HIV-positive patients. TB case detection was significantly higher in HIV-negative patients than in HIV-positive patients when either XpertMTB/Rif and/or ZN was used (P = 0.018 and 0.012, respectively).

CONCLUSION

The use of XpertMTB/Rif has significantly increased TB case detection and data in Cross River State. Scale-up of additional strategies such as culture is still required to improve TB detection in HIV patients.

摘要

目的/背景：全球数据显示，尼日利亚的结核病（TB）相关死亡率最高。过度依赖萋尼氏（ZN）涂片显微镜检查进行诊断以及人类免疫缺陷病毒（HIV）/艾滋病导致防控工作受限。基于聚合酶链反应的新型XpertMTB/Rif（美国加利福尼亚州赛沛公司）可检测结核分枝杆菌和利福平耐药性，于2014年在克罗斯河州引入。我们评估了将XpertMTB/Rif引入克罗斯河州结核病防控项目后肺结核病例检出率的增加情况。

材料与方法

前瞻性收集2014年6月至2015年12月来自克罗斯河州三个XpertMTB/Rif检测中心的数据。从每位患者采集一份即时标本和一份清晨痰标本，使用显微镜进行检测，同时留取一份标本用于XpertMTB/Rif检测。

结果

共评估了2326例患者，其中男性47.4%（1103例），女性52.6%（1223例）。他们的平均年龄为38.8岁（范围4 - 89岁）；42.6%（991例）HIV阳性，50.9%（1183例）HIV阴性，6.5%（158例）HIV状态未知。XpertMTB/Rif在22.9%（534例）的患者中检测到结核分枝杆菌，而ZN涂片阳性率为16.8%（391例）。涂片显微镜检查漏诊了24.5%（131/534）的病例（P < 0.0001）。根据HIV状态对患者进行分类时，XpertMTB/Rif在HIV阴性患者中检测出23.7%（280/1183），ZN涂片显微镜检查检测出18.5%（219/1183）。XpertMTB/Rif在HIV阳性患者中检测出21.5%（213/991），ZN涂片检测出14.1%（140/991）。当使用XpertMTB/Rif和/或ZN时，HIV阴性患者的结核病病例检出率显著高于HIV阳性患者（分别为P = 0.018和0.012）。