Win E E, Kumar A M V, Kyaw N T T, Aye N N, Hteik K M, Saw S, Oo M M, Kyaw K W Y, Aung S T, Tun T L
Health Literacy Promotion Unit, Department of Public Health, Ministry of Health and Sports, Sagaing, Myanmar.
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
Public Health Action. 2018 Dec 21;8(4):169-174. doi: 10.5588/pha.18.0041.
Ten selected microscopy centres in Sagaing Region, Myanmar, functioning under an external quality assurance system with no reported major errors. To assess the pattern of serial sputum results (NN, both smear-negative; NP, first smear-negative and second smear-positive; PN, first smear-positive and second smear-negative; and PP, both smear-positive) among follow-up sputum microscopy examinations of tuberculosis (TB) patients (end of intensive phase, mid-continuation phase and end of treatment) conducted from 1 November 2017 to 15 April 2018. Cross-sectional study using secondary data (laboratory registers). Of 2001 examinations, 94 (4.7%) were smear-positive: 66 PP (3.3%), 12 PN (0.6%) and 16 NP (0.8%); 75% of NP results were scanty. The proportion of NP results was 0.8% (95%CI 0.5-1.3), i.e., 125 smears (95%CI 77-200) were required to detect one additional smear-positive result in the second sample. Of the 16 NP results (15 patients), 14 were tested using Xpert MTB/RIF and none had rifampicin resistance. During the continuation phase of treatment, 13 became smear-negative, one remained smear-positive and one had unknown follow-up smear status. The benefit of the second sputum sample for monitoring anti-tuberculosis treatment was negligible. Given the favourable resource implications (reduced laboratory workload and costs), we recommend changing the policy from two sputum smears to one during follow-up sputum examinations of TB patients.
缅甸实皆省的10个选定显微镜检查中心在外部质量保证体系下运作，未报告重大错误。旨在评估2017年11月1日至2018年4月15日对结核病患者（强化期末、继续期中和治疗结束时）进行的后续痰涂片显微镜检查中连续痰检结果的模式（NN，两次涂片均阴性；NP，第一次涂片阴性且第二次涂片阳性；PN，第一次涂片阳性且第二次涂片阴性；PP，两次涂片均阳性）。使用二手数据（实验室登记册）进行横断面研究。在2001次检查中，94次（4.7%）涂片阳性：66次PP（3.3%）、12次PN（0.6%）和16次NP（0.8%）；NP结果中75%为少量菌。NP结果的比例为0.8%（95%CI 0.5 - 1.3），即需要125次涂片（95%CI 77 - 200）才能在第二个样本中检测到另外一个涂片阳性结果。在16次NP结果（15名患者）中，14次使用Xpert MTB/RIF检测，均未发现利福平耐药。在治疗的继续期，13人涂片转阴，1人仍为涂片阳性，1人后续涂片状态不明。第二个痰样本对监测抗结核治疗的益处可忽略不计。鉴于对资源的有利影响（减少实验室工作量和成本），我们建议在结核病患者的后续痰检中将政策从两次痰涂片改为一次。
