A COMPARATIVE-STUDY OF THE POLYMERASE CHAIN-REACTION AND CONVENTIONAL PROCEDURES FOR THE DIAGNOSIS OF TUBERCULOUS PLEURAL EFFUSION
A COMPARATIVE-STUDY OF THE POLYMERASE CHAIN-REACTION AND CONVENTIONAL PROCEDURES FOR THE DIAGNOSIS OF TUBERCULOUS PLEURAL EFFUSION
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DOI：
10.1016/0962-8479(92)90130-c
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发表时间：
1992-10-01
期刊：
影响因子：
--
通讯作者：
STEYN, L
中科院分区：
文献类型：
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作者：
DEWIT, D;MAARTENS, G;STEYN, L
我们和其他人的初步报告表明，通过聚合酶链反应（PCR）扩增分枝杆菌DNA是一种敏感和快速的结核病诊断试验。最近，我们描述了一种PCR检测与结核分枝杆菌特异性的336 bp的重复序列作为DNA靶，这给了令人鼓舞的结果，在培养阳性涂片阴性的临床标本。在目前的前瞻性研究患者胸腔积液，我们比较了PCR的胸腔积液与传统的程序。84例成人胸腔积液患者分为4组。A组44例，M.结核性胸膜炎通过胸水培养、胸膜活检或胸膜外来源检出。B组（6例）经组织学证实为结核感染（排除A组）。C组（3例患者）有结核病的临床证据。D组（31例患者）没有活动性M的证据。肺结核感染。胸水分析证实PCR的敏感性为81%。胸水培养、胸膜活检组织培养和胸膜活检组织学检查的敏感性分别为52.8%、69.8%和77.3%。D组有7例PCR阳性，其中6例为恶性胸腔积液。通过分析胸水确定，结核病PCR比实验室培养更敏感。恶性胸腔积液患者的阳性PCR结果可能是假阳性或潜在结核感染的结果。在高流行率和低流行率地区的前瞻性研究对PCR检测的特异性进行严格评价之前，PCR应继续作为一种研究性方法。
Preliminary reports by ourselves and others suggest that amplification of mycobacterial DNA by the polymerase chain reaction (PCR) is a sensitive and rapid diagnostic test for tuberculosis. We recently described a PCR assay with a 336 bp repetitive sequence specific for Mycobacterium tuberculosis as the DNA target, which gave encouraging results in culture-positive smear-negative clinical specimens. In the present prospective study of patients with pleural effusions we compared PCR of the pleural fluid with conventional procedures.84 adult patients with pleural effusions were divided into 4 groups. In group A (44 patients), M. tuberculosis was detected by culture of pleural fluid, pleural biopsy or extrapleural source. In group B (6 patients), tuberculous infection was confirmed by histology (group A excluded). Group C (3 patients) had clinical evidence of tuberculosis. Group D (31 patients) had no evidence of active M. tuberculosis infection. Analysis of the pleural fluid confirmed a sensitivity for PCR of 81 %. The sensitivity of pleural fluid culture, culture of pleural biopsy, and histology of biopsy was 52.8 %, 69.8 % and 77.3 % respectively. There were however 7 PCR positive results within group D; 6 of these were in patients with malignant effusions.We conclude that for the diagnosis of M. tuberculosis PCR is more sensitive than laboratory culture as determined by the analysis of pleural fluids. Positive PCR results among patients with malignant effusions may be false-positives or the result of latent tuberculous infections. PCR should remain an investigational procedure until prospective studies in high and low prevalence areas have critically evaluated the specificity of the assay.