Makambwa E, Maboreke H R, Fadul M, Meldau R, Dhansay M, Esmail A, Dheda K
Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, South Africa.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
Afr J Thorac Crit Care Med. 2019 Jul 31;25(2). doi: 10.7196/AJTCCM.2019.v25i2.011. eCollection 2019.
The performance of Xpert-MTB/RIF, including the newer Xpert Ultra test, for the diagnosis of pleural TB is poor (~28 - 38%). There are no data on patient characteristics that portend a positive Xpert-Ultra test in pleural fluid. These characteristics could be useful for selecting patients for Xpert-Ultra testing, thus maximising benefits of a positive test, while minimising cost.
To determine the clinical, radiological, microbiological and biochemical characteristics associated with Xpert-Ultra positivity in patients with suspected pleural tuberculosis.
We performed a subgroup analysis of a prospective observational cohort (N=165 patients with suspected pleural TB) evaluating same-day diagnostic tools for pleural tuberculosis. Forty-nine patients with confirmed pleural tuberculosis (culture and/or histology) were included in the final analysis.
Of the 49 participants, 17 (35%) were female and 9 (18.4%) were HIV-infected. In the multivariate analysis including demographic, radiological and pleural fluid test characteristics, there were no independent predictors of Xpert-Ultra positivity. However, when pleural fluid test results were excluded, and when only rapidly ascertainable pre-test factors (demographic and radiologic variables) were considered, the multivariable analysis showed that only a chest X-ray (CXR) suggestive of active TB (cavities, consolidation and hilar lymphadenopathy) was associated with Xpert-Ultra positivity (p=0.021). Notably, only 22% (n=11/49) of the participants had a CXR suggestive of active TB and of these, 73% (n=8/11) had a positive Xpert-Ultra result.
CXR features suggestive of active TB are significantly associated with a positive Xpert-Ultra test result on pleural fluid. These data inform clinical practice in resource-poor settings.
包括新型Xpert Ultra检测在内的Xpert-MTB/RIF检测在诊断胸腔结核方面表现不佳（约28%-38%）。目前尚无关于胸腔积液中Xpert-Ultra检测呈阳性的患者特征的数据。这些特征可能有助于选择进行Xpert-Ultra检测的患者，从而在使检测阳性的益处最大化的同时，将成本降至最低。
确定疑似胸腔结核患者中与Xpert-Ultra检测呈阳性相关的临床、放射学、微生物学和生化特征。
我们对一个前瞻性观察队列（N=165例疑似胸腔结核患者）进行了亚组分析，评估胸腔结核的同日诊断工具。最终分析纳入了49例经确诊的胸腔结核患者（培养和/或组织学检查）。
49名参与者中，17名（35%）为女性，9名（18.4%）感染了艾滋病毒。在包括人口统计学、放射学和胸腔积液检测特征的多变量分析中，没有Xpert-Ultra检测呈阳性的独立预测因素。然而，当排除胸腔积液检测结果，且仅考虑快速确定的检测前因素（人口统计学和放射学变量）时，多变量分析显示，只有提示活动性结核的胸部X光片（CXR）（空洞、实变和肺门淋巴结肿大）与Xpert-Ultra检测呈阳性相关（p=0.021）。值得注意的是，只有22%（n=11/49）的参与者胸部X光片提示活动性结核，其中73%（n=8/11）的Xpert-Ultra检测结果为阳性。
提示活动性结核的胸部X光片特征与胸腔积液Xpert-Ultra检测阳性结果显著相关。这些数据为资源匮乏地区的临床实践提供了参考。
