Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis?
Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis?
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DOI：
10.1136/adc.2007.136929
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发表时间：
2009-03-01
影响因子：
5.2
通讯作者：
Hussey, G.
中科院分区：
文献类型：
--
作者：
Hatherill, M.;Hawkridge, T.;Hussey, G.
目的：比较结核分枝杆菌诱导痰（IS）和洗胃（GL）的诊断率在社区setting.Methods：标本采集方法肺结核（PTB）的细菌学确认在南非开普敦附近的结核疫苗试验（2001-2006年）。与结核病接触或兼容的症状的儿童进行了调查，怀疑PTB。在191例培养确诊病例中比较了764对IS和GL标本的诊断率，测量和主要结果：结核分枝杆菌的粗产率为10.4%，IS为108例（5.8%），GL为127例（6.8%），共194例，其中3例IS/GL标本对不完整。IS和GL之间的一致性较差（kappa=0.31）。单个IS样品的比较产率（38%）与单个GL样品（42%）相当，产率差异为24%（95% CI-15%至+ 7%）。同一天IS和GL标本的合并产率（67%）相当于两个连续GL标本（66%），产率差异为1%（95% CI -9%至11%），但显著高于两个连续IS标本（55%），产率差异为12%（95% CI 2%至21%）。结核分枝杆菌文化的调整后的几率增加了结核菌素皮肤试验阳性或胸部X线片兼容PTB.Conclusions：在这个社区设置，诊断率的一个单一的IS样本是相当于一个单一的GL样本。最佳诊断率可从一天采集的配对IS和GL标本或连续几天采集的两个GL标本中获得。
Objectives: To compare the diagnostic yield of Mycobacterium tuberculosis from induced sputum (IS) and gastric lavage (GL) among children in a community setting.Methods: Specimen-collection methods for bacteriological confirmation of pulmonary tuberculosis (PTB) were compared during a tuberculosis vaccine trial near Cape Town, South Africa (2001-2006). Children with a tuberculosis contact or compatible symptoms were investigated for suspected PTB. Diagnostic yields from 764 paired IS and GL specimens were compared in 191 culture-confirmed cases.Measurements and main results: The crude yield of M tuberculosis was 10.4%, n=108 by IS (5.8%) and n=127 by GL (6.8%), from a total of 194 cases, of which three had incomplete IS/GL specimen pairs. Agreement between IS and GL was poor (kappa=0.31). The comparative yield of a single IS sample (38%) was equivalent to a single GL sample (42%), with a difference in yield of 24% (95% CI -15% to + 7%). The combined yield of same-day IS and GL specimens (67%) was equivalent to two consecutive GL specimens (66%), with a difference in yield of 1% (95% CI -9% to 11%), but significantly greater than two consecutive IS specimens (55%), with a difference in yield of 12% (95% CI 2% to 21%). The adjusted odds of a M tuberculosis culture were increased by a positive tuberculin skin test or chest radiograph compatible with PTB.Conclusions: In this community setting, the diagnostic yield of a single IS sample was equivalent to that of a single GL sample. The optimal diagnostic yield may be obtained from paired IS and GL specimens taken on a single day or two GL specimens taken on consecutive days.