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第二次是魅力吗? 评估在低患病率环境下对肺结核的住院诊断算法的敏感性和收益率
Caitlin M Dugdale1,2,3, Kimon C Zachary2,3,4, Dustin S McEvoy5
1Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Open forum infectious diseases
|June 14, 2024
概括
两次酸敏细菌 (AFB) 涂抹检测到肺结核的产量与三次相同,可能减少实验室工作. 核酸放大试验 (NAAT) 显著提高了结核病的诊断灵敏度.
科学领域:
- 肺部医学 肺部医学
- 传染性疾病 传染性疾病
- 诊断微生物学 诊断微生物学
背景情况:
- 目前的指导方针建议对疑似肺结核病进行3次酸快细菌 (AFB) 涂抹和1次核酸放大试验 (NAAT).
- 有限的数据支持用于结核病诊断的AFB涂抹的最佳数量.
- 这项研究评估了在低患病率环境下诊断测试的性能.
研究的目的:
- 为了估计1,2,或3个AFB涂抹的性能,或没有NAATs检测肺结核.
- 为了比较不同测试策略的诊断产量.
主要方法:
- 对怀疑肺结核的住院患者进行了回顾性研究.
- 从呼吸道样本中分析了菌根菌培养,AFB涂抹和NAAT结果.
- 在培养确认病例中评估测试阳性和产量.
主要成果:
- 第一次AFB涂抹检测出39%的培养证实病例中有结核病.
- 第二次AFB涂抹增加了22%的阳性;在两个负面结果之后,没有第三次涂抹呈阳性.
- 在涂抹阴性病例上进行的NAAT产生了23个额外的诊断.
- 使用1或2个NAAT的策略显示出比单独使用3个AFB涂抹 (60%) 更高的灵敏度 (74%-79%).
结论:
- 两次AFB涂抹的诊断产量与肺结核三次涂抹的诊断产量相似.
- 使用1或2个NAAT可以显著提高灵敏度,当与AFB涂抹测试相结合时.
- 优化结核病诊断测试可以减少实验室负担和隔离时间.
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