资源匮乏、结核病负担高地区应用 Xpert/Rifampicin 检测技术诊断儿童结核病的趋势：一项回顾性、多中心研究。

Trends in pediatric tuberculosis diagnosis utilizing xpert /Rifampicin in a poor-resource, high-burden region: A retrospective, multicenter study.

机构信息

Department of Pediatrics, Ahmadu Bello University, Zaria, Kaduna State, Nigeria.

Department of Pediatrics, University of Ibadan, Ibadan, Oyo State, Nigeria.

出版信息

Int J Mycobacteriol. 2023 Jan-Mar;12(1):77-81. doi: 10.4103/ijmy.ijmy_1_23.

DOI:10.4103/ijmy.ijmy_1_23

PMID:36926767

Abstract

BACKGROUND

The burden of tuberculosis (TB) in Nigeria remains high, and diagnosis in children, a challenge. We aimed to document yield from Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) as a mode of diagnosis for children and the variables associated with a positive result.

METHODS

This was a retrospective review of TB treatment cards of children aged 0-15 years managed from January 2017 to December 2021 across six public tertiary institutions in Nigeria. The data obtained were analyzed using the descriptive and inferential statistics. Statistical significance was set at P < 0.05.

RESULTS

Of 1489 children commenced on TB treatment, 1463 (97.9%) had sufficient data for analysis the median age of study participants was 60 months (interquartile range [IQR]: 24, 120), and 814 (55.6%) were males. Xpert MTB/RIF test was performed in 862 (59%) participants and MTB was detected in 171 (19.8%) participants, of which 6.4% (11/171) had RIF resistance reported. The use of Xpert MTB/RIF rose from 56.5% in 2017 to 64% in 2020 but fell to 60.9% in 2021. We found that older age (> 10 years), the presence of pulmonary TB (PTB), and a negative human immunodeficiency virus (HIV) status were associated with positive Xpert MTB/RIF tests (P = 0.002, 0.001, and 0.012, respectively).

CONCLUSION

The utilization of Xpert MTB/RIF in children increased in the years before the COVID-19 pandemic. Factors associated with MTB detection by Xpert MTB/RIF include older age, the presence of PTB, and a negative HIV status. Clinical and radiological evaluation continues to play vital roles in the diagnosis of childhood TB in Nigeria.

摘要

背景

尼日利亚的结核病（TB）负担仍然很高，儿童诊断是一个挑战。我们旨在记录 Xpert 分枝杆菌/利福平（MTB/RIF）检测作为诊断儿童结核病的方法的检出率，并确定与阳性结果相关的变量。

方法

这是一项回顾性研究，对 2017 年 1 月至 2021 年 12 月期间在尼日利亚六家公立三级机构接受治疗的 0-15 岁儿童的结核治疗卡进行了分析。使用描述性和推断性统计方法分析获得的数据。统计学意义设定为 P<0.05。

结果

在接受结核病治疗的 1489 名儿童中，有 1463 名（97.9%）有足够的数据进行分析，研究参与者的中位数年龄为 60 个月（四分位距[IQR]：24，120），814 名（55.6%）为男性。在 862 名（59%）参与者中进行了 Xpert MTB/RIF 检测，在 171 名（19.8%）参与者中检测到 MTB，其中 6.4%（11/171）报告存在利福平耐药。2017 年 Xpert MTB/RIF 的使用率为 56.5%，2020 年上升至 64%，但 2021 年降至 60.9%。我们发现年龄较大（>10 岁）、存在肺结核（PTB）和 HIV 阴性与 Xpert MTB/RIF 检测阳性相关（P=0.002，0.001 和 0.012）。