咳嗽时间、TB可疑患者的特征和医疗服务因素决定了涂片镜检的结果
2010/12/31
摘要
目的：研究常规痰液涂片抗酸杆菌阳性，联合咳嗽时间、TB可疑患者特征和医疗服务因素，在常规结核病病例诊断中的有效性。
方法：来自于圣胡安德鲁里甘乔县、利马、秘鲁的6个医疗机构实验室注册人员的常规数据，联合患者访谈进行分析。若TB可疑患者至少有1次阳性痰液涂片，则诊断为TB。计算涂片阳性和医疗服务与患者特征之间相关性的校正后优势比和95%可信区间。
结果：涂片阳性率为7.3% (321/4376)。在4376名提取痰液的成人患者中，55.3% (2418)的患者主诉咳嗽小于14天。在这组患者，涂片镜检阳性率为3.2% (78/2418)，而咳嗽超过14天的患者阳性率为12.4% (243/1958)。咳嗽超过2周的患者、医护人员咨询的患者、二级医疗机构就诊的患者、男性患者和15～44岁患者是涂片阳性的独立决定因素。
结论：在常规病例检测中，涂片阳性病例比例较低，因为有相当大一部分患者无咳嗽，或者咳嗽小于2周。在检测TB可疑患者时，遵循国家TB控制项目指南，对涂片阳性率具有正面影响，能降低实验室的开支和工作量，并可能改善涂片镜检的读片质量。
（林江涛 审校）
Trop Med Int Health. 2010 Dec;15(12):1475-1480. doi: 10.1111/j.1365-3156.2010.02645.x.
Duration of cough, TB suspects’ characteristics and service factors determine the yield of smear microscopy.
Otero L, Ugaz R, Dieltiens G, González E, Verdonck K, Seas C, Van Deun A, Gotuzzo E, Van der Stuyft P.
Instituto de Medicina Tropical Alexander von Humboldt, Universidad Epidemiology and Disease Control Unit, Peruana Cayetano Heredia, Lima, Peru Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium.
Abstract
OBJECTIVE: To determine the efficiency of routine tuberculosis (TB) case detection by examining sputum smear positivity for acid-fast bacilli in relation to duration of cough, characteristics of TB suspects examined and health service factors.
METHOD: We combined patient interviews with routine data from laboratory registers in 6 health care facilities in San Juan de Lurigancho district, Lima, Peru. A TB case was defined as a TB suspect with at least one positive sputum smear. We calculated adjusted odds ratios with 95% confidence intervals for the association between smear positivity and health service and patient’s characteristics.
RESULTS: Smear positivity was 7.3% (321/4376). Of the 4376 adults submitting sputa, 55.3% (2418) reported cough for <14 days. In this group, smear microscopy yielded 3.2% (78/2418) positive results vs. 12.4% (243/1958) in patients coughing for 14 or more days. Having cough for >2 weeks, being referred by health care staff, attending a secondary-level health care facility, male sex and age between 15 and 44 years were independent determinants of smear positivity.
CONCLUSIONS: Routine case detection yields a low proportion of smear-positive cases because of the inclusion of a high proportion of patients without cough or coughing for <2 weeks. Adherence to the national TB control programme guidelines on the selection of TB suspects would have a positive impact on the smear positivity rate, reduce laboratory costs and workload and possibly improve the reading quality of smear microscopy.
Trop Med IntHealth.2010Dec;15(12):1475-1480.doi:10.1111/j.1365-3156.2010.02645.x.
目的：研究常规痰液涂片抗酸杆菌阳性，联合咳嗽时间、TB可疑患者特征和医疗服务因素，在常规结核病病例诊断中的有效性。
方法：来自于圣胡安德鲁里甘乔县、利马、秘鲁的6个医疗机构实验室注册人员的常规数据，联合患者访谈进行分析。若TB可疑患者至少有1次阳性痰液涂片，则诊断为TB。计算涂片阳性和医疗服务与患者特征之间相关性的校正后优势比和95%可信区间。
结果：涂片阳性率为7.3% (321/4376)。在4376名提取痰液的成人患者中，55.3% (2418)的患者主诉咳嗽小于14天。在这组患者，涂片镜检阳性率为3.2% (78/2418)，而咳嗽超过14天的患者阳性率为12.4% (243/1958)。咳嗽超过2周的患者、医护人员咨询的患者、二级医疗机构就诊的患者、男性患者和15～44岁患者是涂片阳性的独立决定因素。
结论：在常规病例检测中，涂片阳性病例比例较低，因为有相当大一部分患者无咳嗽，或者咳嗽小于2周。在检测TB可疑患者时，遵循国家TB控制项目指南，对涂片阳性率具有正面影响，能降低实验室的开支和工作量，并可能改善涂片镜检的读片质量。
（林江涛 审校）
Trop Med Int Health. 2010 Dec;15(12):1475-1480. doi: 10.1111/j.1365-3156.2010.02645.x.
Duration of cough, TB suspects’ characteristics and service factors determine the yield of smear microscopy.
Otero L, Ugaz R, Dieltiens G, González E, Verdonck K, Seas C, Van Deun A, Gotuzzo E, Van der Stuyft P.
Instituto de Medicina Tropical Alexander von Humboldt, Universidad Epidemiology and Disease Control Unit, Peruana Cayetano Heredia, Lima, Peru Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium.
Abstract
OBJECTIVE: To determine the efficiency of routine tuberculosis (TB) case detection by examining sputum smear positivity for acid-fast bacilli in relation to duration of cough, characteristics of TB suspects examined and health service factors.
METHOD: We combined patient interviews with routine data from laboratory registers in 6 health care facilities in San Juan de Lurigancho district, Lima, Peru. A TB case was defined as a TB suspect with at least one positive sputum smear. We calculated adjusted odds ratios with 95% confidence intervals for the association between smear positivity and health service and patient’s characteristics.
RESULTS: Smear positivity was 7.3% (321/4376). Of the 4376 adults submitting sputa, 55.3% (2418) reported cough for <14 days. In this group, smear microscopy yielded 3.2% (78/2418) positive results vs. 12.4% (243/1958) in patients coughing for 14 or more days. Having cough for >2 weeks, being referred by health care staff, attending a secondary-level health care facility, male sex and age between 15 and 44 years were independent determinants of smear positivity.
CONCLUSIONS: Routine case detection yields a low proportion of smear-positive cases because of the inclusion of a high proportion of patients without cough or coughing for <2 weeks. Adherence to the national TB control programme guidelines on the selection of TB suspects would have a positive impact on the smear positivity rate, reduce laboratory costs and workload and possibly improve the reading quality of smear microscopy.
Trop Med IntHealth.2010Dec;15(12):1475-1480.doi:10.1111/j.1365-3156.2010.02645.x.
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随机临床试验：大剂量胃酸抑制剂治疗慢性咳嗽——一项双盲、安慰剂对照研究
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长期低剂量红霉素治疗不明原因咳嗽：一项双盲安慰剂对照试验
