Diktanas Saulius, Vasiliauskiene Edita, Polubenko Katazyna, Danila Edvardas, Celedinaite Indre, Boreikaite Evelina, Misiunas Kipras
Vilnius University Hospital Santariskiu Klinikos, Center of Pulmonology and Allergology, Vilnius, Lithuania.
Vilnius University Hospital Santariskiu Klinikos, Center of Laboratory Medicine, Vilnius, Lithuania.
Tuberc Respir Dis (Seoul). 2018 Jul;81(3):233-240. doi: 10.4046/trd.2017.0096. Epub 2018 Jun 19.
Non-conversion of sputum smear and culture prolongs the infectivity of the patient and has been associated with unfavorable outcomes. We aimed to evaluate factors associated with persistent sputum positivity at the end of two months of treatment of new case pulmonary tuberculosis (TB).
Data of 87 human immunodeficiency virus-negative patients with culture-positive drug-susceptible pulmonary TB admitted to local university hospital between September 2015 and September 2016 were reviewed. Factors associated with sputum smear and/or culture positivity at the end of the second month of treatment were analyzed.
Twenty-two patients (25.3%) remained smear and/or culture-positive. Male sex, lower body mass index (BMI), unemployment, alcohol abuse, higher number of lobes involved and cavities on chest X-rays, shorter time to detection (TTD) on liquid cultures, higher respiratory sample smear grading and colony count in solid cultures, higher C-reactive protein, erythrocyte sedimentation rate, leukocytosis, thrombocytosis, and anemia were all significantly associated with persistent sputum positivity. However, in the logistic regression analysis only male sex, lower BMI, alcohol abuse, higher radiological involvement, cavitation, higher smear grading, higher colony count in solid cultures and shorter TTD were determined as independent factors associated with persistent sputum positivity at the end of 2 months of treatment.
In conclusion, higher sputum smear and culture grading at diagnosis, shorter TTD, higher number of lobes involved, cavitation, male sex, alcohol abuse, and lower BMI were independently associated with persistent sputum positivity. These factors should be sought when distinguishing which patients will remain infectious longer and possibly have worse outcomes.
痰涂片和培养结果未转阴会延长患者的传染性，并与不良预后相关。我们旨在评估新诊断肺结核患者治疗两个月结束时痰持续阳性的相关因素。
回顾了2015年9月至2016年9月间入住当地大学医院的87例人类免疫缺陷病毒阴性、培养阳性的药物敏感型肺结核患者的数据。分析了治疗第二个月结束时与痰涂片和/或培养阳性相关的因素。
22例患者（25.3%）痰涂片和/或培养仍为阳性。男性、较低的体重指数（BMI）、失业、酗酒、胸部X线显示累及肺叶数量较多和有空洞、液体培养检测时间（TTD）较短、呼吸道样本涂片分级较高和固体培养菌落计数较高、较高的C反应蛋白、红细胞沉降率、白细胞增多、血小板增多和贫血均与痰持续阳性显著相关。然而，在逻辑回归分析中，只有男性、较低的BMI、酗酒、较高的影像学累及程度、空洞形成、较高的涂片分级、固体培养菌落计数较高和较短的TTD被确定为治疗两个月结束时与痰持续阳性相关的独立因素。
总之，诊断时痰涂片和培养分级较高、TTD较短、累及肺叶数量较多、空洞形成、男性、酗酒和较低的BMI与痰持续阳性独立相关。在区分哪些患者传染性持续时间更长且可能预后更差时，应寻找这些因素。
