Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
Sci Rep. 2022 Jul 14;12(1):12064. doi: 10.1038/s41598-022-16319-8.
The clinical impact of nucleic acid amplification (NAA) tests on reducing delayed diagnosis and misdiagnosis of pulmonary TB (PTB) has rarely been investigated. PTB patients were classified into a frontline NAA group, an add-on NAA group, and a no NAA group. The outcomes of interest were the proportion of PTB case died before anti-TB treatment, the interval between sputum examination and initiation of treatment, and misdiagnosis of PTB. A total of 2192 PTB patients were enrolled, including 282 with frontline NAA, 717 with add-on NAA, and 1193 with no NAA tests. Patients with NAA tests had a lower death rate before treatment initiation compared to those without NAA tests (1.6% vs. 4.4%, p < 0.001) in all cases. Patients with frontline NAA compared to those with add-on NAA and those without NAA, had a shorter interval between sputum examination and treatment initiation in all cases (3 days vs. 6 days (p < 0.001), vs 18 days (p < 0.001)), and less misdiagnosis in smear-positive cases (1.8% vs. 5.6% (p = 0.039), vs 6.5% (p = 0.026)). In conclusion, NAA tests help prevent death before treatment initiation. Frontline NAA tests perform better than add-on NAA and no NAA in avoiding treatment delay in all cases, and misdiagnosis of PTB in smear-positive cases.
核酸扩增 (NAA) 检测对减少肺结核 (PTB) 延迟诊断和误诊的临床影响很少被研究。PTB 患者被分为一线 NAA 组、附加 NAA 组和无 NAA 组。主要观察指标是抗结核治疗前 PTB 病例死亡的比例、痰检与治疗开始之间的间隔时间以及 PTB 的误诊。共纳入 2192 例 PTB 患者，其中 282 例进行了一线 NAA，717 例进行了附加 NAA，1193 例未进行 NAA 检测。所有患者中，NAA 检测组在开始治疗前的死亡率均低于无 NAA 检测组（1.6% vs. 4.4%，p<0.001）。所有患者中，与附加 NAA 组和无 NAA 组相比，一线 NAA 组痰检与治疗开始之间的时间间隔更短（3 天 vs. 6 天（p<0.001），18 天（p<0.001）），且在涂片阳性病例中误诊率更低（1.8% vs. 5.6%（p=0.039），6.5%（p=0.026））。总之，NAA 检测有助于防止治疗前死亡。一线 NAA 检测在所有情况下都优于附加 NAA 和无 NAA 检测，避免了治疗延迟，并减少了涂片阳性病例的误诊。
