1999年初,埃塞俄比亚索马里地区发现的肺结核(PTB)病例中48％者为痰涂片阳性。于是提出实验室水平上的质量强化措施,并对痰涂片阴性的肺结核诊断进行复核。临床医生虽然了解国家结核病规划关于肺结核诊断的基本原则,但并没有完全遵循这些原则,部分是因为考虑到病人的费用问题。 通过上述非威胁性方式对临床医生提出挑战,发挥其临床实践当中的积极主动性获得了巨大成功,涂阳肺结核比例增至65％。需要开展研究以评估这些广泛推行的涂阴肺结核诊断指南的可行性。 In early 1999, 48% of the cases of pulmonary tuberculosis (PTB) found in the Somali region of Ethiopia were sputum smear-positive. Therefore, quality-enhancing measures at the laboratory level were proposed and the diagnosis of sputum smear-negative pulmonary tuberculosis was reviewed. Clinicians, while aware of the basic principles of the national tuberculosis program regarding the diagnosis of tuberculosis, did not follow these principles fully, in part because of the patient’s costs. By challenging the clinicians in the non-threatening way described above, the initiative to play their clinical practice has been a huge success, with the proportion of smear-positive TB increasing to 65%. Research is needed to assess the feasibility of these widespread guidelines for diagnosis of smear-negative tuberculosis.