Diagnostic yield of sputum, induced sputum, and bronchoscopy after radiologic tuberculosis screening
Diagnostic yield of sputum, induced sputum, and bronchoscopy after radiologic tuberculosis screening
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DOI：
10.1164/rccm.200608-1092oc
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发表时间：
2007-01-01
影响因子：
24.7
通讯作者：
Thurnheer, Robert
中科院分区：
文献类型：
--
作者：
Schoch, Otto D.;Rieder, Philippe;Thurnheer, Robert
基本原理：评估在三个主要入境点对寻求庇护者进行放射学筛查后发现结核病病例后诊断程序的可行性和产量。方法：前瞻性多中心研究，探讨症状、自发痰和诱导痰以及支气管镜检查对放射学选定病例中结核病确诊的价值。结果：在接受检查的101名寻求庇护者中，83人“当场”采集了自发痰，13例痰涂片阳性病例中有7例（54%），33例培养阳性病例中有13例（39%）。84例患者采集晨痰，分别产生8例（62%）和16例（49%），两种自发性痰分别产生9例（69%）和20例（61%）。在91人中收集的另外两个诱导的嗜酸细胞，没有产生额外的涂片阳性，但产生了7个培养阳性病例（产率，82%）。在92例痰涂片阴性的病例中，有87例进行了支气管镜检查，另外有4例痰涂片阳性和6例培养阳性。通过使用支气管镜检查获得标本（调整后的比值比，11.0; 95%置信区间，1.9-62）和先前决定治疗（调整后的比值比，3.0;置信区间，1.1-8.1），可以独立和显著地预测培养确认。结论：在筛查过程中发现的与结核病相符的放射学异常是开始治疗的不良指南。呼吸道和全身症状与结核病的培养确认弱相关。所有放射学选择的病例，无论症状如何，都必须进行现场和清晨痰检。如果两份标本均为涂片阴性，则通过支气管镜检查增加产率，并在较小程度上通过两份诱导痰样本增加产率。任何单一标本的检查都有36%至63%的低产率，不足以排除活动性结核。
Rationale: To assess feasibility and yield of diagnostic procedures after active case finding for tuberculosis with radiologic screening at the three main entry points for asylum seekers to Switzerland.Method: Prospective multicenter study on the value of symptoms, spontaneous and induced sputum, and bronchoscopy for the confirmation of tuberculosis in radiologically selected cases.Results: Among 101 asylum seekers examined, spontaneous sputum was collected "on the spot" in 83 and yielded 7 (54%) of 13 smear-positive and 13 (39%) of 33 culture-positive cases. Morning sputum, collected in 84, yielded 8 (62%) and 16 (49%), and the two spontaneous sputa combined 9 (69%) and 20 (61%), respectively. Two additional induced sputa, collected in 91 persons, yielded no additional smear-positive, but yielded seven culture-positive cases (yield, 82%). Bronchoscopy, performed in 87 of 92 sputum smear-negative cases, yielded four additional smear-positive and six culture-positive cases. Culture confirmation was independently and significantly predicted by obtaining a specimen using bronchoscopy (adjusted odds ratio, 11.0; 95% confidence interval, 1.9-62) and a prior decision to treat (adjusted odds ratio, 3.0; confidence interval, 1.1-8.1).Conclusion: Radiographic anomalies compatible with tuberculosis found during screening are a poor guide to initiation of treatment. Respiratory and systemic symptoms correlated weakly with culture confirmation of tuberculosis. All radiologically selected cases must be examined with on-the-spot and early-morning sputum, regardless of symptoms. If both specimens are smear negative, the yield is increased by bronchoscopy and, to a lesser extent, by two samples of induced sputum. The examination of any single specimen has a low yield of 36 to 63% and is insufficient to exclude active tuberculosis.