Mvo Sidwell, Bokop Carine, Longo-Mbenza Benjamin, Vasaikar Sandeep D, Apalata Teke
Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa.
Vaccine and Infectious Disease Analytics Research Unit, University of the Witwatersrand, Johannesburg 2000, South Africa.
Pathogens. 2023 Sep 5;12(9):1133. doi: 10.3390/pathogens12091133.
The study sought to determine factors associated with prolonged smear positivity in multidrug-resistant tuberculosis (MDR-TB) patients following appropriate management. Newly diagnosed patients were enrolled between June 2017 and May 2018. Sputum samples were collected for Xpert MTB/RIF and line probe assays (LiPAs). Microscopic tests were performed at baseline and 4, 8, and 12 weeks post-anti-TB therapy. Of the 200 patients, 114 (57%) were HIV-positive. After 12 weeks of treatment, there was a significant microscopy conversion rate among DS-TB patients compared to MDR-TB patients irrespective of their HIV status ( = 0.0013). All MDR-TB patients who had a baseline smear grade ranging from scanty to +1 converted negative, while 25% ranging from +2 to +3 remained positive until the end of 12 weeks ( = 0.014). Factors associated with smear positivity included age <35 years ( = 0.021), initial CD4+ T-cell count ≥200 cells/mm ( = 0.010), and baseline smear grade ≥2+ ( = 0.014). Cox regression showed that only the baseline smear grade ≥2+ was independently associated with prolonged smear positivity in MDR-TB patients ( = 0.011) after adjusting for HIV status, CD4+ T-cell count, and age. Baseline sputum smear grade ≥2+ is a key determinant for prolonged smear positivity beyond 12 weeks of effective anti-TB therapy in MDR-TB patients.
该研究旨在确定在接受适当管理后，耐多药结核病（MDR-TB）患者涂片持续阳性的相关因素。2017年6月至2018年5月纳入新诊断患者。收集痰液样本进行Xpert MTB/RIF和线性探针分析（LiPA）。在抗结核治疗基线及治疗后4周、8周和12周进行显微镜检查。200例患者中，114例（57%）HIV检测呈阳性。治疗12周后，无论HIV状态如何，与耐多药结核病患者相比，药物敏感结核病（DS-TB）患者的显微镜转阴率有显著差异（P = 0.0013）。所有基线涂片等级为少量至+1的耐多药结核病患者涂片转为阴性，而25%涂片等级为+2至+3的患者在12周结束时仍为阳性（P = 0.014）。涂片阳性相关因素包括年龄<35岁（P = 0.021）、初始CD4+ T细胞计数≥200个细胞/mm³（P = 0.010）和基线涂片等级≥2+（P = 0.014）。Cox回归显示，在调整HIV状态、CD4+ T细胞计数和年龄后，仅基线涂片等级≥2+与耐多药结核病患者涂片持续阳性独立相关（P = 0.011）。基线痰涂片等级≥2+是耐多药结核病患者在有效抗结核治疗12周后涂片持续阳性的关键决定因素。
