Background:Tuberculosis(TB)remains a major threat to human health,and TB diagnostic methods remain unsatisfactory.Nucleic acid amplification tests(NAATs)show higher sensitivity compared with culture for the diagnosis ...Background:Tuberculosis(TB)remains a major threat to human health,and TB diagnostic methods remain unsatisfactory.Nucleic acid amplification tests(NAATs)show higher sensitivity compared with culture for the diagnosis of pulmonary TB(PTB).However,NAATs are expensive and cannot be easily implemented outside major medical centers.To improve the sensitivity of NAATs for PTB diagnosis,we investigated the predictive factors that might optimize NAAT utilization.Methods:A total of 1263 patients with suspected PTB were enrolled for evaluation.The sensitivity,specificity,and accuracy of methods including smear-microbiology,culture of Mtb and NAAT for Mycobacterium tuberculosis(Mtb)detection in sputum and bronchoalveolar lavage fluid samples were compared.Odds ratios and 95%confidence intervals were used to assess variables that might be associated with positive NAAT results for sputum and bronchoalveolar lavage fluid from patients with suspected PTB.Results:NAAT showed higher sensitivity for Mtb detection(61.1%)when compared with smear(9.0%)and Mtb culture(47.8%).We found that an elevated erythrocyte sedimentation rate,the presence of cavities,and positive interferon-𝛾release assay(IGRA)results were indicative of positive Mtb detection by NAAT.Moreover,individuals who had all three of these characteristics showed an 86%diagnostic positivity for PTB from Mtb detection by NAAT.Conclusions:Our study suggests that an elevated erythrocyte sedimentation rate,a positive IGRA result,and the presence of pulmonary cavities are helpful factors for predicting positive Mtb detection by NAAT.Patients with the three positive clinical markers should undergo NAAT for Mtb detection because they are the most likely individuals to be bacteriologically confirmed as having TB.展开更多
目的探讨RNA恒温扩增实时检测技术(simultaneous amplification and testing,SAT)在结核病诊断中的应用价值。方法采用RNA扩增实时检测试剂盒分别检测175例肺结核病患者、211例其他肺部疾病患者,并与痰菌培养及痰涂片比较检测的灵敏度...目的探讨RNA恒温扩增实时检测技术(simultaneous amplification and testing,SAT)在结核病诊断中的应用价值。方法采用RNA扩增实时检测试剂盒分别检测175例肺结核病患者、211例其他肺部疾病患者,并与痰菌培养及痰涂片比较检测的灵敏度和特异性,同时对培养阳性菌株进行鉴定。结果以临床诊断为"金标准",SAT检测结核病患者的敏感度为71.43%、特异度为99.05%,结核患者阳性检出率明显高于痰培养法和痰涂片法(P<0.01);386例标本中有20例鸟-胞内分枝杆菌、4例脓肿分枝杆菌、1例戈登分枝杆菌、1例堪萨斯分枝杆菌、6例鸟分枝杆菌,SAT检测NTM结果均为阴性;SAT对涂阳培阳患者检出率为100%,涂阴培阳检出率78.4%,涂阴培阴检出率为56%,涂阳培阴检出率为35.7%。结论 RNA扩增实时检测技术检测肺结核具有快速方便、经济和较高的敏感度,值得用于临床结核筛查。展开更多
基金This work was supported by the Natural Science Foundation of China(No.81,873,958,81,802,058)the National Key Research and Development Plan(No.2019YFC0840602,2020YFA0907201)+2 种基金the Guang-dong Scientific and Technological Foundation(No.2019B1515120041,2020B1111170014)the Shen-zhen Scientific and Technological Foundation(No.JCYJ20180228162336873,JCYJ20180228162321234,KCXFZ202002011007083)the China Postdoctoral Science Foundation(No.2020M670085ZX).
文摘Background:Tuberculosis(TB)remains a major threat to human health,and TB diagnostic methods remain unsatisfactory.Nucleic acid amplification tests(NAATs)show higher sensitivity compared with culture for the diagnosis of pulmonary TB(PTB).However,NAATs are expensive and cannot be easily implemented outside major medical centers.To improve the sensitivity of NAATs for PTB diagnosis,we investigated the predictive factors that might optimize NAAT utilization.Methods:A total of 1263 patients with suspected PTB were enrolled for evaluation.The sensitivity,specificity,and accuracy of methods including smear-microbiology,culture of Mtb and NAAT for Mycobacterium tuberculosis(Mtb)detection in sputum and bronchoalveolar lavage fluid samples were compared.Odds ratios and 95%confidence intervals were used to assess variables that might be associated with positive NAAT results for sputum and bronchoalveolar lavage fluid from patients with suspected PTB.Results:NAAT showed higher sensitivity for Mtb detection(61.1%)when compared with smear(9.0%)and Mtb culture(47.8%).We found that an elevated erythrocyte sedimentation rate,the presence of cavities,and positive interferon-𝛾release assay(IGRA)results were indicative of positive Mtb detection by NAAT.Moreover,individuals who had all three of these characteristics showed an 86%diagnostic positivity for PTB from Mtb detection by NAAT.Conclusions:Our study suggests that an elevated erythrocyte sedimentation rate,a positive IGRA result,and the presence of pulmonary cavities are helpful factors for predicting positive Mtb detection by NAAT.Patients with the three positive clinical markers should undergo NAAT for Mtb detection because they are the most likely individuals to be bacteriologically confirmed as having TB.
文摘目的探讨RNA恒温扩增实时检测技术(simultaneous amplification and testing,SAT)在结核病诊断中的应用价值。方法采用RNA扩增实时检测试剂盒分别检测175例肺结核病患者、211例其他肺部疾病患者,并与痰菌培养及痰涂片比较检测的灵敏度和特异性,同时对培养阳性菌株进行鉴定。结果以临床诊断为"金标准",SAT检测结核病患者的敏感度为71.43%、特异度为99.05%,结核患者阳性检出率明显高于痰培养法和痰涂片法(P<0.01);386例标本中有20例鸟-胞内分枝杆菌、4例脓肿分枝杆菌、1例戈登分枝杆菌、1例堪萨斯分枝杆菌、6例鸟分枝杆菌,SAT检测NTM结果均为阴性;SAT对涂阳培阳患者检出率为100%,涂阴培阳检出率78.4%,涂阴培阴检出率为56%,涂阳培阴检出率为35.7%。结论 RNA扩增实时检测技术检测肺结核具有快速方便、经济和较高的敏感度,值得用于临床结核筛查。
