关键词: 肺结核, 非结核病定点医院, 实验室检测技术, 效果评价

Abstract:

Objective To investigate the application and effectiveness of different laboratory testing technologies in the tuberculosis patients at first visit in the non-designated tuberculosis hospitals for evidences in optimizing the testing procedures for diagnosis of tuberculosis in these hospitals. Methods The pulmonary tuberculosis patients who were initially registered and admitted in six non-designated hospitals in Wuhan City and subsequently confirmed as tuberculosis in the designated hospital, reported in the Infectious Disease Reporting and Management System under the China Information System for Disease Control and Prevention from January 2021 to June 2022, were included as study subjects. Individual patient data were collected from the Infectious Disease Reporting System, and tuberculosis-related test results, diagnostic information, and other data during the patients′ visits were gathered from the information systems of the non-designated hospitals. Then the detection rate was compared among the patients underwent single or combined tests in the non-designated hospitals by different laboratory testing technologies. Finally, the days of diagnosis, cost of diagnosis, and detection of rifampicin resistance were analyzed between patients who received GeneXpert MTB/RIF (GeneXpert) system test and those who did not. Results A total of 386 confirmed tuberculosis patients were finally included, in whom 8 were rifampicin resistant. When a single laboratory testing technology was used in non-designated hospitals, the detection rate by GeneXpert system, mycobacterial culture, tuberculosis deoxyribonucleic acid test (TB-DNA) and smear acid-fast staining was 86.79% (138/159), 79.37% (50/63), 75.00% (45/60) and 48.25% (138/286), respectively. When two laboratory testing technologies were applied in combination, the detection rate by GeneXpert system + mycobacterial culture, GeneXpert + smear acid-fast staining, and smear acid-fast staining + mycobacterial culture arrived at 90.00% (45/50), 84.75% (100/118) and 79.66% (47/59), respectively. The average days to tuberculosis diagnosis and the average diagnostic cost for patients who underwent GeneXpert system testing were 1 (1, 1) day and (2 039 ± 2 075) yuan, respectively, compared to 4 (2, 9) days and (3 140 ± 4 557) yuan for those who did not undergo GeneXpert system testing. The difference was significant (H=110.975, t=-3.198, both P<0.01). In both the GeneXpert group and the non-GeneXpert group, there were 4 patients resistant to rifampin. The GeneXpert group detected 3 cases, while the non-GeneXpert group did not detect any. Conclusion The average cost of diagnosis is relatively lower by application of GeneXpert test for detection of tuberculosis in non-tuberculosis designated hospitals, and combined GeneXpert system with other detection technology and routine sputum examination can be conductive to diagnosis of common tuberculosis and rifampicin-resistant tuberculosis, which is of great significance for rapid sourcing of the infection and control of tuberculosis spreading.

Key words: Pulmonary tuberculosis, Non-tuberculosis designated hospital, Laboratory testing technology, Effect evaluation