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Accuracy and incremental yield of urine Xpert MTB/RIF Ultra versus Determine TB-LAM for diagnosis of pulmonary tuberculosis.

尿Xpert MTB/RIF Ultra与Determine TB-LAM诊断肺结核的准确性和增量产量。

  • 影响因子:2.31
  • DOI:10.1016/j.diagmicrobio.2019.114892
  • 作者列表:"Andama A","Jaganath D","Crowder R","Asege L","Nakaye M","Katumba D","Mwebe S","Semitala F","Worodria W","Joloba M","Mohanty S","Somoskovi A","Cattamanchi A
  • 发表时间:2020-01-01
Abstract

:The performance of urine Xpert MTB/RIF Ultra (Xpert Ultra) for pulmonary TB diagnosis is unknown. HIV-positive and HIV-negative adults were enrolled at two health facilities in Kampala, Uganda. We compared the accuracy of urine Xpert Ultra and Determine TB-LAM in reference to sputum-based testing (positive Xpert MTB/RIF or culture), and assessed incremental yield. Urine Xpert Ultra had low sensitivity (17.2%, 95% CI 12.3-23.2) but high specificity (98.1%, 95% CI 94.4-99.6). Sensitivity reached 50.0% (95% CI 28.2-71.8) among HIV-positive patients with CD4 <100 cells/μL. Compared to Determine TB-LAM, urine Xpert Ultra was 9.4% (95% CI 3.8-14.9, P = 0.01) more sensitive, and 17.2% (95% CI 4.5-29.8, P = 0.01) more sensitive among HIV-positive patients. However, the incremental sensitivity of urine Xpert Ultra relative to sputum Xpert MTB/RIF was only 1% (95% CI -0.9 to 2.8). Urine Xpert Ultra could be an alternative for patients with advanced HIV infection unable to produce sputum.

摘要

: 尿液Xpert MTB/RIF Ultra (Xpert Ultra) 用于肺结核诊断的性能尚不清楚。在乌干达坎帕拉的两个卫生机构登记了HIV阳性和HIV阴性的成年人。我们比较了尿液Xpert Ultra和测定TB-LAM的准确性,以痰为基础的检测 (Xpert MTB/RIF阳性或培养阳性),并评估了增量产量。尿Xpert Ultra敏感性低 (17.2%,95% CI 12.3-23.2),特异性高 (98.1%,95% CI 94.4-99.6)。在CD4 <50.0% 个细胞/μ l的HIV阳性患者中,敏感性达到 95% (28.2 CI 71.8-100)。与确定TB-LAM相比,尿Xpert Ultra更敏感 9.4% (95% CI 3.8-14.9,p = 0.01),17.2% (95% CI 4.5-29.8,P = 0.01) 在HIV阳性患者中更敏感。然而,尿Xpert超相对于痰Xpert MTB/RIF的增量敏感性仅为 1% (95% CI -0.9 ~ 2.8)。尿液Xpert Ultra可能是晚期HIV感染患者无法产生痰液的替代方法。

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呼吸道感染方向

呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。

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