Gomez-Pastrana D, Torronteras R, Caro P, Anguita M L, Barrio A M, Andrés A, Navarro J
Department of Pediatrics, Virgen del Rocío University Children's Hospital, Seville, Spain.
Pediatr Pulmonol. 1999 Nov;28(5):344-51. doi: 10.1002/(sici)1099-0496(199911)28:5<344::aid-ppul6>3.0.co;2-d.
We investigated the value of the polymerase chain reaction (PCR) in the diagnosis of active tuberculosis in children and evaluated the relationship between PCR results in children with tuberculous infections and mediastinal adenopathies detected by computerized tomography (CT-Scan). This was a controlled, blinded, prospective study comparing nested PCR, mycobacterial cultures and the clinical diagnosis based on 350 clinical specimens from 117 children referred for evaluation of suspected pulmonary tuberculosis. All children with tuberculous infection but without active disease underwent a chest CT-scan to detect the presence of mediastinal adenopathies not evident on chest x-ray. The sensitivity of PCR was 56.8% in children with clinically active disease (culture: 37.8%; smears: 13.5%). A major advantage of PCR over cultures was noted when there was no parenchymal involvement on chest radiograph and when the patient was undergoing anti-tuberculous treatment. There were nine specimens with false-negative PCR results due to the presence of amplification reaction inhibitors. PCR was positive in five children with tuberculous infection without active disease and these children presented mediastinal adenopathies on the CT-scan that were not evident on chest radiography. There were no false-positive PCR results in the control groups of children. We conclude that nested PCR is a rapid and sensitive method for the early diagnosis of tuberculosis in children. It is especially useful when the diagnosis of active tuberculosis is difficult. In our study children with tuberculous infection without apparent disease who have positive PCR results have mediastinal adenopathies on CT-scan.
我们研究了聚合酶链反应（PCR）在儿童活动性结核病诊断中的价值，并评估了结核感染儿童的PCR结果与计算机断层扫描（CT扫描）检测到的纵隔淋巴结肿大之间的关系。这是一项对照、盲法、前瞻性研究，比较了巢式PCR、分枝杆菌培养以及基于117名因疑似肺结核转诊儿童的350份临床标本的临床诊断。所有结核感染但无活动性疾病的儿童均接受胸部CT扫描，以检测胸部X线片上不明显的纵隔淋巴结肿大情况。在临床活动性疾病儿童中，PCR的敏感性为56.8%（培养：37.8%；涂片：13.5%）。当胸部X线片无实质受累且患者正在接受抗结核治疗时，PCR相对于培养的一个主要优势得以体现。由于存在扩增反应抑制剂，有9份标本的PCR结果为假阴性。5名结核感染但无活动性疾病的儿童PCR呈阳性，这些儿童在CT扫描上显示有纵隔淋巴结肿大，而胸部X线片上不明显。对照组儿童中没有PCR假阳性结果。我们得出结论，巢式PCR是儿童结核病早期诊断的一种快速且敏感的方法。当活动性结核病诊断困难时尤其有用。在我们的研究中，PCR结果呈阳性的无明显疾病的结核感染儿童在CT扫描上有纵隔淋巴结肿大。
