Evaluation of polymerase chain reaction for detection of Mycobacterium tuberculosis in pleural fluid
Evaluation of polymerase chain reaction for detection of Mycobacterium tuberculosis in pleural fluid
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DOI：
10.1378/chest.119.6.1737
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发表时间：
2001-06-01
期刊：
影响因子：
9.6
通讯作者：
Arora, SK
中科院分区：
文献类型：
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作者：
Nagesh, BS;Sehgal, S;Arora, SK
目的：结核病是一种新发的杀手，在全球范围内呈严重流行趋势，尤其是在艾滋病流行的情况下，利用聚合酶链式反应(PCR)检测临床标本中的分枝杆菌DNA是一种有希望的快速诊断结核感染的方法。本研究的目的是评价聚合酶链式反应检测胸腔积液中结核分枝杆菌，并将检测结果与腺苷脱氨酶活性(ADA)、抗酸杆菌(AFB)检测结果进行相关性分析。方法：以40例非结核性胸腔积液为对照，评价聚合酶链式反应检测胸腔积液中结核分枝杆菌DNA的敏感性和特异性。检测结果与60例胸腔积液的ADA呈正相关。结果：在20例结核性胸腔积液标本中，AFB染色4例可检出分支杆菌。有14份标本为PCR阳性。对照组无一例AFB或PCR阳性。因此，该方法的灵敏度为70.0%，特异度为100%(阳性预测值为100%，阴性预测值为86.95%)。AFB筛查的敏感性最高可达20%。结核性胸腔积液ADA值平均值为63.21un(SD，33，01)，对照组ADA平均值为51.1un(SD，29，71)。以50U/L为界值，ADA法诊断肺结核的灵敏度和特异度均为55%。结论：聚合酶链式反应是一种快速、灵敏的检测胸腔积液中分枝杆菌DNA的方法，AFB筛查敏感性低，ADA法敏感性和特异度均较低。因此，当临床怀疑很高，涂片结果为阴性时，但结核分枝杆菌的体征和症状是识别感染的。
Objectives: Tuberculosis a reemergent killer, is threatening to assume serious proportions all over the world, particularly in view of the AIDS pandemic, The detection of mycobacterial DNA by polymerase chain reaction (PCR) in clinical samples is a promising approach for the rapid diagnosis of tuberculous infections. The aims of this study were to evaluate PCR for detection of Mycobacterium tuberculosis in pleural fluids and to correlate the results with adenosine deaminase activity (ADA) estimation acid acid-fast bacilli (AFB) screening.Methods: The sensitivity and specificity of PCR in detection of mycobacterial DNA in 20 samples of tuberculous pleural effusion were evaluated using 40 samples of nontubercular pleural effusion as controls. The results were correlated with the,ADA in all 60 pleural fluids. In addition, AFB detection by Ziehl-Neelsen staining on cytospin smears of all pleural fluids was also compared.Results: Of the 20 samples of tuberculous pleural effusion, mycobacterium could be detected by AFB staining in 4 samples. Fourteen samples were PCR positive. None of the samples from the control group were AFB or PCR positive. The sensitivity of PCR, therefore, was 70.0% with specificity of 100% (positive predictive value, 100%; negative predictive value, 86.95%). The sensitivity of AFB screening was at best 20%. The mean of ADA values in tubercular pleural effusions was 63.21 Un (SD, 33,01), and the mean in the control samples was 51.1 Un (SD, 29,71). Taking a cut-off value of 50 U/L, both the sensitivity and specificity of ADA estimation in diagnosing tuberculosis were only 55%.Conclusion: PCR represents a rapid and sensitive method for the detection of mycobacterial DNA in tuberculous pleural effusions, AFB screening has low sensitivity, and ADA estimation has both low sensitivity and specificity. Therefore, when die clinical suspicion is high and smear result is negative, but the signs and symptoms of M tuberculosis are identifying the infection.