石家庄市结核病实验室监测情况分析

目的了解石家庄18个市管县结核病实验室痰涂片室质控工作。方法检测全市18个市管县疾病预防控制中心结核病实验室。结果现场抽样痰涂片总数2320张,其中阳性痰涂片326张,阴性痰涂片1994张,盲法复检和第二复检者完成后的结果痰涂片合格率98.4%。结论石家庄市18个市管县结核病实验室室间质控情况仍存在误差,有待提高。     

2011年新疆结核病痰涂片室间质量控制结果分析

目的了解新疆结核病防治机构结核病参比实验室痰涂片制作的质量和痰检工作质量。方法按照"中国结核病防治规划痰涂片镜检质量保证手册"的要求,采用盲法复检痰涂片的方法,对全疆2011年部分结核病防治机构进行一次痰涂片室间质控的抽查。结果共抽查583张痰涂片,其中抗酸杆菌阳性片符合率90.8%、阴性片符合率97.3%,发现低假阳性涂片10张,低假阴性涂片13张,出现量化误差的涂片9张;痰膜面积合格率96.6%,厚薄合格率86.8%,染色合格率87.8%,痰膜脱落合格率96.4%。结论新疆各级结核病实验室的痰检人员较好地掌握了痰涂片的制作要求,但各地实验室之间痰检工作质量和水平参差不齐,有待进一步提高。     

2007～2009年结核病实验室室间质量评估效果分析

目的通过室间质量控制来提高各级结核病实验室工作质量。方法采用盲法复检的方法对19个县级结核病实验室痰涂片的制备、染色、读片、结果判断等技术进行评估,再根据评估结果制定有针对性的措施。对问题县进行现场督导和一对一培训。对2007～2009室间质量评估结果进行分析,来评价近几年的实验室质量控制效果。结果 3年间共抽取县级痰涂片6852张,痰片制作合格6714,合格率达97%;假阳性65张,假阳性率不到0.9%,假阴性10张,假阴性率为0.1%。痰涂片质量和结果判定,合格率、准确率逐年提高。合格率从2007年的90%,提高到2009年98%。阳性符合率、阴性符合率从2007年的95%,96%,提高到2009年的99.8%,99.9%。结论采用室间质量控制是提高县级结核病实验室工作质量的重要保证。     

台州市不同医疗机构痰涂片室间质控效果评价

目的为了评价台州市各县(市、区)结核病实验室痰涂片质量和镜检能力,提高结核病痰涂片镜检质量。方法按照《中国结核病防治规划——痰涂片镜检质量保证手册》(EQA)的要求,对结核病实验室进行现场评价和盲法复检。结果复检符合率98.6%、阳性符合率96.1%、阴性符合率99.1%、综合医院符合率98.9%、结防机构符合率98.1%。痰涂片质量指标:痰细胞、大小、厚薄、染色、脱落合格率分别为89.5%、69.5%、72.9%、91.5%、97.4%。结论EQA盲法复检和实验室现场评价,有利于发现问题,及时有效的纠正错误。     

台州市不同医疗机构痰涂片室间质控效果评价

目的为了评价台州市各县（市、区）结核病实验室痰涂片质量和镜检能力，提高结核病痰涂片镜检质量。方法按照《中国结核病防治规划——痰涂片镜检质量保证手册》（EQA）的要求，对结核病实验室进行现场评价和盲法复检。结果复检符合率98.6%、阳性符合率96.1%、阴性符合率99.1%、综合医院符合率98.9%、结防机构符合率98.1%。痰涂片质量指标：痰细胞、大小、厚薄、染色、脱落合格率分别为89.5%、69.5%、72.9%、91.5%、97.4%。结论 EQA盲法复检和实验室现场评价，有利于发现问题，及时有效的纠正错误。     

双盲法痰检室间质控三年效果评价

目的　探讨在结核病控制规程中痰涂片室间质控的新模式。方法 以新登记肺结核病人痰涂片为质控重点,在区县级实验室之间,开展双盲初级室间质控,省级参比室进行终级质控考核。结果 在不增加经费投入情况下,地区质控覆盖率可达100%,每年约50%新登记肺结核病人痰涂片置于质量监控之下。镜下阳性符合率从本课题实施前99.0%～100%下降至97.1%～98.3%,阴性符合率由99.4%～99.9%下降至98.5%～99.1%。结论 采用双盲法开展同级间室间质控,是经济可行的一种间接督导方式,可有效地扩大质控范围和质控频率;两级双重室间质控使质量控制程序更趋严格,可切实发挥痰检质控在结核病控制规划中的作用。     

肺结核病人痰涂片镜检不同质控方式效果评价

目的 探讨适合我国各级实验室开展的痰涂片室间质量控制模式?方法 设计了在不同地理条件下应用不同督导方式进行痰涂片镜检室间质控?结果及结论 经培训后直接督导和间接督导之间?山区和平原之间复检痰片的各项符合率均无统计学差异?直接督导费用明显高于间接督导;山区督导费用明显高于平原(P<0.05)?结合二种督导方式在各自实施中的特点,认为培训和室间质控是提高痰检质量的必要手段,在我国现阶段可根据各地区的疫情?结防力量?痰检水平和经费等实际情况,采取两种督导方式相结合?偏重其中一种模式进行痰涂片镜检质量控制?     

痰涂片制片质量对镜检工作效率影响的研究

痰涂片镜检作为发现传染源、选择化疗方案、考核评价疗效的重要手段,在现代结核病控制中占有不可或缺的地位。加强痰涂片的质量控制,提高各级实验室的痰检工作效率已成为当前国家结核病控制规程实施中的重要内容。本文通过对一次痰涂片镜检室间质控数据的分析,阐明痰涂片制片质量因素对镜检工作效率的影响。     

新疆乌鲁木齐市实验室痰检工作的探讨

目的 探讨加强各级医疗机构实验室痰检工作,提高涂阳肺结核病人发现率.方法 根据乌鲁木齐市结核病控制工作中的各种原始登记资料,结合结核病流行病学抽样调查结果,对实验室痰检工作和结核病人发现进行分析.结果 1996-2004年乌鲁木齐市结核病控制工作,结防机构实验室室间质量控制指标、可疑者查痰率、痰菌涂阳检出率达到工作要求的标准.结核病人涂阳登记率21.17/10万～26.53/10万.结论 痰检质控工作覆盖至各级医疗机构实验室,全面提高痰涂片检验人员的素质,是提高病人的早期发现率的重要途径.     

肺结核病人痰涂片镜检室间质量保证模式的评价研究

目的了解痰涂片抗酸菌镜检室间质量评估体系(EQA)在提高相应检验工作质量中的作用。方法比较新旧2种EQA模式的结果差异,分析相应结果对提高结核病痰涂片镜检质量的作用。结果旧模式统计的阳性符合率为97.1%(578/595),阴性符合率为99.1%(1 135/1 145)。新模式统计的的阳性符合率是89.6%(225/251),阴性符合率是98.7%(1 067/1 081)。新的EQA模式的样本抽取和盲法复检方式,较以往模式更能反映被评估实验室的日常工作状态;新EQA摸式增加的痰标本性状和量化误差更能反映被评估实验室相应检验项目中存在的问题以及改进方向。结论新的EQA模式在操作上可行,且结果对促进痰涂片镜检质量提高更具指导意义。     

甘肃省乡级查痰点工作开展情况调查

目的了解甘肃省设立乡镇卫生院结核病痰涂片检查点(以下简称"乡级查痰点")以来(2005—2007年上半年)工作开展情况,为制定下一步乡级查痰点工作计划,规范乡级查痰点的工作提供科学依据。方法调查全省乡级查痰点基本情况、2005—2007年上半年乡级查痰点工作开展情况,分析查痰点存在的问题。结果甘肃省共设查痰点535个,痰检人员均为兼职。2005、2006、2007年上半年:痰检工作量为18 416、17 7989、242人份;发现涂阳病人1 001、936、395例;20%~33%的查痰点没有开展工作;年工作量大于50例的查痰点只占20%~24%,菌阳检出率4.3%~5.4%低于县级结核病细菌学实验室水平。结论甘肃省乡级查痰点在我省涂阳病人发现上做出一定的贡献,但乡级查痰点人员均为兼职、实验条件及安全防护差、工作开展不平衡、技术水平低。乡级查痰点工作现状应引起卫生行政部门及各级结核病防治机构的重视,应根据各地的不同情况,结合人口、县级工作需求、查痰点服务半径以及覆盖人口,减少查痰点的数量,并制定切实可行的措施,理顺工作程序,整合有限的资金,改善实验室工作条件,进一步规范乡级查痰点工作。     

新疆维吾尔自治区综合医疗机构痰检质控工作评价

目的分析新疆维吾尔自治区综合医疗机构痰检质控工作情况,探讨提高痰检质量的有效措施。方法根据自治区疾病预防控制中心结核病控制中心对全区综合医疗机构的督导记录和痰涂片复检质控结果、进行综合分析和评价。结果2007年53家基层综合医疗机构,共登记可疑肺结核症状者21313例,查痰6989例发现涂阳肺结核403例,涂阳检出率5.8％。未查痰病人转至结防机构查痰5972例,发现涂阳肺结核2030例,涂阳检出率34.0％。涂阴病人转至结防机构再查痰3940例,涂阳肺结核893例,涂阳检出率22.7％。结防机构查痰29048例,涂阳9896例,涂阳检出率34.1％,与综合医疗机构比较差异有统计学意义（P<0.05）。结论加强综合医疗机构与结防机构的合作。对综合医疗机构痰涂片检查人员进行业务培训及复训,提高痰检质控质量,保证检出率,以达到提高涂阳病例发现的目的。     

Validation of the surveillance system for tuberculosis in Botswana.

SETTING: Gaborone and Francistown, Botswana, where surveillance data in the 1997 Electronic Tuberculosis (TB) Register suggest that 39% of pulmonary TB patients did not have pre-treatment sputum smear microscopy performed. OBJECTIVE: To determine the proportion of patients with reportedly missing pre-treatment sputum smear results in 1997 who had smears examined, and to identify stages in the system where results were lost. METHODS: Patients with pulmonary TB in 1997 who were missing pre-treatment sputum smear results in the Electronic TB Register were cross-matched with laboratory records; medical records were reviewed. RESULTS: Of 374 patients with pre-treatment sputum smear results missing, 224 (60%) actually had had a sputum smear examined in the laboratory. The proportion of pulmonary TB patients in Gaborone and Francistown who did not have sputum examined was therefore 16% instead of 39%. Most missing results (69%) had not been transcribed from the laboratory results onto the TB Treatment Card. Patients who had a negative smear result or who sought care at a clinic that was different from where their diagnostic evaluation had been initiated were more likely to have missing results. CONCLUSIONS: The actual performance of the Botswana National TB Programme with respect to sputum microscopy examination is much better than surveillance indicators suggest. In addition to sputum collection, proper recording of results needs reinforcement among health care workers to improve routine performance indicators.     

新疆乌鲁木齐市实验室痰检工作的探讨

目的探讨加强各级医疗机构实验室痰检工作,提高涂阳肺结核病人发现率。方法根据乌鲁木齐市结核病控制工作中的各种原始登记资料,结合结核病流行病学抽样调查结果,对实验室痰检工作和结核病人发现进行分析。结果1996—2004年乌鲁木齐市结核病控制工作,结防机构实验室室间质量控制指标、可疑者查痰率、痰菌涂阳检出率达到工作要求的标准。结核病人涂阳登记率21.17/10万26.53/10万。结论痰检质控工作覆盖至各级医疗机构实验室,全面提高痰涂片检验人员的素质,是提高病人的早期发现率的重要途径。     

甘肃省乡镇卫生院查痰点资源及工作情况分析

目的了解甘肃省乡镇卫生院结核病痰涂片检查点资源及工作现状,为今后开展查痰点工作提供参考。方法对甘肃省535个乡镇卫生院查痰点基本情况和2005—2008年开展痰涂片检查情况进行分析。结果甘肃省535个查痰点中,目前开展工作的占66.5%。仅有3.0%的痰检人员专职。2005—2008年共对80889例肺结核可疑症状者进行痰涂片检查,发现涂阳患者4065例,涂阳患者检出率为5.0%。假阳254张,假阴3019张。各年的阳性符合率明显低于国家规定标准。结论乡级查痰点在我省涂阳患者发现上所起作用有限,查痰点实验条件及安全防护差、工作开展不平衡。应根据各地的不同情况,制定切实可行的措施,因地制宜,整合有限的资源,改善实验室工作条件,进一步规范乡级查痰点工作。     

综合医院结核病查痰点痰检工作分析

目的分析综合医院门诊可疑肺结核症状者查痰工作情况,探讨综合医院提高涂阳病人发现的措施。方法根据综合医院和结防机构门诊病人登记本、查痰登记本、转诊登记本及结防机构对综合医院的督导和痰检质量控制情况进行综合分析和评价。结果40所综合医院1年间,共登记可疑肺结核症状者11 303例,发现涂阳肺结核859例,涂阳检出率15.6%,转到结防机构的涂阴及未查痰病人2 094例,在结防机构查痰1 685例,发现涂阳肺结核804例,涂阳检出率47.7%,其中未查痰直接转到结防机构查痰1 026例,发现涂阳肺结核551例,涂阳检出率53.7%,痰阴病人转到结防机构再查痰659例,发现涂阳肺结核253例,涂阳检出率38.4%,结防机构门诊查痰25 238例,涂阳检出率55.7%,与综合医院涂阳检出率比较差异有显著性(P<0.05)。结论在综合医院建立查痰点,加大行政干预力度,加强综合医院与结防机构的合作,医院内相关科室建立协调机制,将痰检工作纳入综合医院临床检查常规项目,加强痰检质量控制和结防专业机构对综合医院相关专业人员的培训和复训,是提高传染源发现水平的有效途径。     

Duration of cough, TB suspects' characteristics and service factors determine the yield of smear microscopy

Objective To determine the efficiency of routine tuberculosis (TB) case detection by examining sputum smear positivity for acid‐fast bacilli in relation to duration of cough, characteristics of TB suspects examined and health service factors. Method We combined patient interviews with routine data from laboratory registers in 6 health care facilities in San Juan de Lurigancho district, Lima, Peru. A TB case was defined as a TB suspect with at least one positive sputum smear. We calculated adjusted odds ratios with 95% confidence intervals for the association between smear positivity and health service and patient’s characteristics. Results Smear positivity was 7.3% (321/4376). Of the 4376 adults submitting sputa, 55.3% (2418) reported cough for <14 days. In this group, smear microscopy yielded 3.2% (78/2418) positive results vs. 12.4% (243/1958) in patients coughing for 14 or more days. Having cough for >2 weeks, being referred by health care staff, attending a secondary‐level health care facility, male sex and age between 15 and 44 years were independent determinants of smear positivity. Conclusions Routine case detection yields a low proportion of smear‐positive cases because of the inclusion of a high proportion of patients without cough or coughing for <2 weeks. Adherence to the national TB control programme guidelines on the selection of TB suspects would have a positive impact on the smear positivity rate, reduce laboratory costs and workload and possibly improve the reading quality of smear microscopy.     

The significance of the persistent presence of acid-fast bacilli in sputum smears in pulmonary tuberculosis.

STUDY OBJECTIVES: Identification of acid-fast bacilli (AFB) in the sputum smear at the completion of tuberculosis therapy is in some settings considered evidence of treatment failure. However, some patients with pulmonary tuberculosis (TB) will have positive smear results with negative sputum culture results at the end of therapy. The objectives of this study were to estimate the prevalence of persisting positive sputum smear results in patients with TB and to identify characteristics that distinguish patients with persistently positive sputum smear results who also had negative sputum culture results from patients identified as treatment failures. DESIGN: A population-based, historical cohort study with nested case control study. SETTING: British Columbia Division of Tuberculosis Control central case registry. PATIENTS: All 428 patients with culture-proven pulmonary TB in British Columbia over 7 years with sputum that was positive for AFB. METHODS: Review of laboratory data of all 428 patients, as well as clinical data of a subset of 30 patients with persistently positive smear results beyond 20 weeks. RESULTS: Sputum smears were positive for AFB in 205 patients (48%) at 4 weeks, in 30 patients (7%) at 20 weeks, and in 12 patients (3%) at 36 weeks. Of the patients with smear results that were persistently positive at 20 weeks, 23 (77%) had negative sputum culture results and 7 (23%) had positive sputum culture results (ie, they were treatment failures). Patients identified as treatment failures had more localized disease as shown on chest radiographs, had less radiographic improvement at follow-up, had a higher prevalence of drug resistance, and were less compliant with medications than patients with persistently positive smear results and negative culture results. No subject with a negative culture result relapsed over the 6- to 48-month observation period. CONCLUSION: Sputum that is persistently positive for AFB in patients in developed countries is more likely to be associated with negative culture results than with treatment failure.     

Efficiency of a third serial sputum smear examination in the diagnosis of tuberculosis in Moldova and Uganda.

SETTING: Twenty-four and 30 tuberculosis (TB) microscopy laboratories in Moldova and Uganda, respectively. OBJECTIVE: To estimate the workload required to identify one additional case of TB with a third serial sputum smear examination. METHODS: Retrospective laboratory register study to determine the prevalence and the incremental yield of TB cases from a third serial sputum smear examination among suspects in Moldova and Uganda, with the reciprocal of the product of these two fractions providing the number of examinations required to identify one additional TB case. RESULTS: In Moldova, 9% (1141/12525) and in Uganda 20% (7280/36054) of suspects met the TB case definition with at least one positive sputum smear. The incremental yield from the third examination was 4% in Moldova and 3% in Uganda. To detect one additional TB case on a third smear, 273 examinations (95%CI 200-389) in Moldova and 175 (95%CI 153-222) in Uganda were thus required. This corresponded to an average of 11 days (8-16) and 7 days (6-9), respectively, to diagnose one additional case of TB. CONCLUSION: In both countries, the third serial sputum smear examination was inefficient in diagnosing sputum smear-positive TB.