Association of Xpert MTB/RIF Cycle Threshold Values with Tuberculosis Treatment Outcomes
Association of Xpert MTB/RIF Cycle Threshold Values with Tuberculosis Treatment Outcomes
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DOI：
10.1007/s00408-020-00398-3
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发表时间：
2020-10-31
期刊：
影响因子：
5
通讯作者：
Silva, Denise Rossato
中科院分区：
文献类型：
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作者：
Pires, Matheus de Matto;Pereira, Giovana Rodrigues;Silva, Denise Rossato
目的考虑到世界卫生组织目前建议用Xpert MTB/RIF取代痰涂片显微镜检查作为结核病（TB）的初步诊断检测，并且培养需要时间才能提供结果，因此Xpert检测的循环阈值（C-T）可能是评估细菌载量的唯一方法。本研究的目的是评价Xpert C-T测量的细菌负荷与TB治疗结局的相关性。方法采用队列研究的方法，对治愈和未治愈（失败和死亡）患者的Xpert C-T值进行评价。进行多变量分析以评估C-T是否与TB治疗结果独立相关。结果155例患者（治愈84例，未治愈71例）符合纳入标准，全部纳入分析。Xpert MTB/RIF检测的平均C-T值在治愈患者中为20.7 +/- 5.6，在未治愈患者中为17.1 +/- 5.6（p < 0.0001）。未治愈患者既往结核病史（28.2%）高于治愈患者（7.1%）（p < 0.0001）。未治愈患者比治愈患者年轻（37.1 +/- 13.3 vs 43.6 +/- 16.2; p = 0.006）。HIV在未治愈患者（28.2%）中的发生率高于治愈患者（15.5%），但差异无统计学意义（p = 0.054）。在多变量分析中，C-T值、年龄、既往TB和HIV与未治愈独立相关。结论较低的Xpert MTB/RIF C-T值与较差的治疗结局独立相关。在开始治疗之前进行的一次测试的信息被证明是结核病治疗结果的相对较好的预测因素。
Purpose Considering the current recommendation of the World Health Organization to replace sputum smear microscopy with Xpert MTB/RIF as an initial diagnostic test for tuberculosis (TB), and that culture takes time to provide results, the cycle threshold (C-T) of the Xpert test may be the only way to assess bacillary load. The objective of this study is to evaluate the association of bacillary load, measured by the Xpert C-T, with the TB treatment outcomes. Methods In cohort study, Xpert C-T values were evaluated in cured and non-cured (failure and death) patients. Multivariate analysis was performed to evaluate if C-T is independently associated with TB treatment outcomes. Results During this study period, 155 patients (84 cured and 71 non-cured) met the inclusion and were included in the analysis. The mean C-T value for Xpert MTB/RIF test was 20.7 +/- 5.6 in cured patients and 17.1 +/- 5.6 in non-cured patients (p < 0.0001). Previous TB was more frequent in non-cured (28.2%) than in cured patients (7.1%) (p < 0.0001). Non-cured patients were younger than cured ones (37.1 +/- 13.3 vs 43.6 +/- 16.2; p = 0.006). HIV was more frequent in non-cured (28.2%) than in cured patients (15.5%), although this difference was not statistically significant (p = 0.054). In multivariate analysis, C-T values, age, previous TB, and HIV were independently associated with non-cure. Conclusions Lower Xpert MTB/RIF C-T values were independently associated with worse treatment outcomes. The information from even a single test performed before starting treatment proved to be a relatively good predictor of TB treatment outcome.