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首页> 外文期刊>Thorax: The Journal of the British Thoracic Society >Accuracy and impact of Xpert MTB/RIF for the diagnosis of smear-negative or sputum-scarce tuberculosis using bronchoalveolar lavage fluid
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Accuracy and impact of Xpert MTB/RIF for the diagnosis of smear-negative or sputum-scarce tuberculosis using bronchoalveolar lavage fluid

机译：Xpert MTB / RIF使用支气管肺泡灌洗液诊断涂片阴性或痰少的结核病的准确性和影响

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Rationale The accuracy and impact of new tuberculosis (TB) tests, such as Xpert MTB/RIF, when performed on bronchoalveolar lavage fluid (BALF) obtained from patients with sputum-scarce or smear-negative TB is unclear. Methods South African patients with suspected pulmonary TB (n=160) who were sputum-scarce or smear-negative underwent bronchoscopy. MTB/RIF was performed on uncentrifuged BALF (1 ml) and/or a resuspended pellet of centrifuged BALF (～10 ml). Time to TB detection and anti-TB treatment initiation were compared between phase one, when MTB/RIF was performed as a research tool, and phase two, when it was used for patient management. Results 27 of 154 patients with complete data had culture-confirmed TB. Of these, a significantly lower proportion were detected by smear microscopy compared with MTB/RIF (58%, 95% CI 39% to 75% versus 93%, 77% to 98%; p<0.001). Of the 127 patients who were culture negative, 96% (91% to 98%) were MTB/RIF negative. When phase two was compared with phase one, MTB/RIF reduced the median days to TB detection (29 (18-41) to 0 (0-0); p<0.001). However, more patients initiated empirical therapy (absence of a positive test in those commencing treatment) in phase one versus phase two (79% (11/14) versus 28% (10/25); p=0.026). Consequently, there was no detectable difference in the overall proportion of patients initiating treatment (26% (17/67; 17% to 37%) versus 36% (26/73; 26% to 47%); p=0.196) or the days to treatment initiation (10 (1-49) versus 7 (0-21); p=0.330). BALF centrifugation, HIV coinfection and a second MTB/RIF did not result in detectable changes in accuracy. Conclusions MTB/RIF detected TB cases more accurately and more rapidly than smear microscopy and significantly reduced the rate of empirical treatment.
机译：原理尚不清楚对从痰少或涂片阴性结核病患者获得的支气管肺泡灌洗液（BALF）进行的新结核病（TB）测试（如Xpert MTB / RIF）的准确性和影响。方法对南非怀疑肺结核（n = 160），痰少或涂片阴性的患者进行支气管镜检查。在未离心的BALF（1 ml）和/或重悬的BALF离心沉淀（〜10 ml）上进行MTB / RIF。在第一阶段（将MTB / RIF用作研究工具）和第二阶段（用于患者管理）之间，比较了结核病检测和抗结核治疗启动时间。结果154例完整数据的患者中有27例经培养证实为结核病。其中，与MTB / RIF相比，通过涂片显微镜检出的比例明显更低（58％，95％CI为39％至75％，而93％，77％至98％; p <0.001）。在127例培养阴性的患者中，有96％（91％至98％）的MTB / RIF阴性。当将第二阶段与第一阶段进行比较时，MTB / RIF将检测到结核病的中位数天数从29（18-41）减少到0（0-0）; p <0.001）。但是，更多的患者在第一阶段和第二阶段开始了经验疗法（开始治疗的患者中没有阳性试验）（79％（11/14）对28％（10/25）; p = 0.026）。因此，开始治疗的患者总比例（26％（17/67; 17％至37％）与36％（26/73; 26％至47％）; p = 0.196）之间没有可察觉的差异。开始治疗的天数（10（1-49）对7（0-21）; p = 0.330）。 BALF离心，HIV合并感染和第二次MTB / RIF并未导致可检测的准确性变化。结论MTB / RIF比涂片显微镜能更准确，更快速地检测出结核病病例，并显着降低了经验治疗率。

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