Vidal R, Martin-Casabona N, Juan A, Falgueras T, Miravitlles M
Department of Pneumology, Ciutat Sanitaria Universitaria Vall d'Hebron,Barcelona, Spain.
Chest. 1996 Jun;109(6):1562-5. doi: 10.1378/chest.109.6.1562.
A group of patients with pulmonary tuberculosis (PT) who received and correctly completed antituberculous therapy were studied to determine the incidence and significance of positive acid-fast bacilli (AFB) in sputum smears at the end of this treatment.
Retrospective chart review of persons with bacteriologically proved PT.
Of 1,052 patients diagnosed as having PT between 1988 and 1992, 453 who fulfilled the following criteria were included in the study: (1) diagnosis established by positive AFB and positive culture in sputum smears; (2) no previous antituberculous treatment had been received; (3) HIV serologic test results were negative; (4) treatment was correctly completed; (5) they were followed up throughout the period of treatment; and (6) expectoration was still present at the end of treatment and at least two spontaneous sputum samples could be obtained.
Positive AFB of sputum smears were found at the end of treatment in 10 (2.2%) of the 453 patients studied. Five patients had only one positive smear, and the other five had more than one. Of these ten cases, sputum culture was negative in eight, which were considered to be unviable bacilli, and positive for nontuberculous mycobacteria in two. Clinical symptoms or worsening on chest radiograph were observed only in one patient with unviable bacilli, but they were caused by a concomitant nonspecific respiratory tract infection.
Positive AFB smear results at the end of completed treatment regimens analyzed in this study have occurred because of unviable bacilli and nontuberculous mycobacteria colonization. The presence of more than one positive smear seems not to increase the probability of treatment failure and is more frequently due to nontuberculous mycobacteria. Results of culture can thus be awaited without the need to prolong or modify antituberculous therapy.
对一组接受并正确完成抗结核治疗的肺结核（PT）患者进行研究，以确定治疗结束时痰涂片抗酸杆菌（AFB）阳性的发生率及意义。
对细菌学确诊为PT的患者进行回顾性病历审查。
在1988年至1992年期间诊断为PT的1052例患者中，453例符合以下标准的患者被纳入研究：（1）痰涂片AFB阳性且培养阳性确诊；（2）既往未接受过抗结核治疗；（3）HIV血清学检测结果为阴性；（4）治疗正确完成；（5）在整个治疗期间接受随访；（6）治疗结束时仍有咳痰且至少可获得两份自发痰液样本。
在所研究的453例患者中，10例（2.2%）在治疗结束时痰涂片AFB阳性。5例患者仅有一次涂片阳性，另外5例有多次阳性。在这10例病例中，8例痰培养阴性，被认为是无活力的杆菌，2例非结核分枝杆菌阳性。仅1例有无活力杆菌的患者观察到临床症状或胸部X线恶化，但这是由并发的非特异性呼吸道感染引起的。
本研究分析的完成治疗方案结束时AFB涂片阳性是由于无活力杆菌和非结核分枝杆菌定植。多次涂片阳性似乎不会增加治疗失败的概率，且更常见于非结核分枝杆菌。因此可以等待培养结果，而无需延长或修改抗结核治疗。
