Zimba Onani, Tamuhla Tsaone, Basotli Joyce, Letsibogo Gaoraelwe, Pals Sherri, Mathebula Unami, Mathoma Anikie, Serumola Christopher, Ramogale Kitso, Boyd Rosanna, Tran Tiffany, Finlay Alyssa, Auld Andrew, Date Anand, Alexander Heather, Chihota Violet, Agizew Tefera
Centers for Disease Control and Prevention, Botswana.
Botswana University of Pennsylvania, Botswana.
Pan Afr Med J. 2019 Jun 13;33:110. doi: 10.11604/pamj.2019.33.110.15319. eCollection 2019.
The World Health Organization endorsed (2010) the use of Xpert MTB/RIF and countries are shifting from smear microscopy (smear)-based to Xpert MTB/RIF-based tuberculosis (TB) diagnostic algorithms. As with smear, sputum quality may predict the likelihood of obtaining a bacteriologically-confirmed TB when using Xpert MTB/RIF.
From 08/12-11/2014, all people living with HIV were recruited at 22 clinics. For patients screened positive using the four TB symptoms their sputa were tested by Xpert MTB/RIF and smear. Laboratorians assessed and recorded sputum appearance and volume. The yield of bacteriologically-positive sputum evaluated using Xpert MTB/RIF and smear, likelihood-ratios were calculated.
Among 6,041 patients enrolled 2,296 were presumptive TB, 1,305 (56.8%) had > 1 sputa collected and 644/1,305 (49.3%) had both Xpert MTB/RIF and smear results. Since >1 sputa collected from 644 patients 954 sputa were tested by Xpert MTB/RIF and smear. Bacteriologically-positive sputum was two-fold higher with Xpert MTB/RIF 11.4% versus smear 5.3%, p < 0.001. Sputum appearance and quantity were not predictive of bacteriologically-positive results, except volume of 2ml to < 3ml, tested by Xpert MTB/RIF LR+= 1.26 (95% CI, 1.05-1.50).
Xpert MTB/RIF test yield to bacteriologically-positive sputum was superior to smear. Sputum quality and quantity, however, were not consistently predictive of bacteriologically-positive results by Xpert MTB/RIF or smear.
世界卫生组织（2010年）认可使用Xpert MTB/RIF，各国正从基于涂片显微镜检查（涂片）的结核病（TB）诊断算法转向基于Xpert MTB/RIF的算法。与涂片一样，痰液质量可能会预测使用Xpert MTB/RIF时获得细菌学确诊结核病的可能性。
2014年8月12日至11月期间，在22家诊所招募了所有艾滋病毒感染者。对于使用四种结核病症状筛查呈阳性的患者，其痰液通过Xpert MTB/RIF和涂片进行检测。实验室人员评估并记录痰液外观和量。计算使用Xpert MTB/RIF和涂片评估的细菌学阳性痰液的检出率及似然比。
在纳入的6041名患者中，2296名疑似患有结核病，1305名（56.8%）采集了超过一份痰液样本，644/1305名（49.3%）同时有Xpert MTB/RIF和涂片检测结果。由于从644名患者中采集了超过一份痰液样本，共954份痰液样本通过Xpert MTB/RIF和涂片进行检测。Xpert MTB/RIF检测出的细菌学阳性痰液是涂片的两倍，分别为11.4%和5.3%，p<0.001。痰液外观和量不能预测细菌学阳性结果，除了2ml至<3ml的量，Xpert MTB/RIF检测的阳性似然比LR+=1.26（95%CI，1.05 - 1.50）。
Xpert MTB/RIF检测细菌学阳性痰液的检出率优于涂片。然而，痰液质量和量并不能始终预测Xpert MTB/RIF或涂片检测的细菌学阳性结果。
