Chierakul N, Chaiprasert A, Tingtoy N, Arjratanakul W, Pattanakitsakul S N
Department of Medicine, Division of Respiratory Disease and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
Respirology. 2001 Dec;6(4):305-9. doi: 10.1046/j.1440-1843.2001.00355.x.
The aim of this study was to assess the use of qualitative one-tube nested polymerase chain reaction (PCR) for monitoring the treatment response in smear-positive pulmonary tuberculosis, and the factors determining the negative conversion of sputum smear, culture, and PCR during treatment.
A total of 53 patients receiving a standard short course of chemotherapy with 24 months follow-up period after treatment cessation were included in the study. Sputum specimens were collected serially for smear, culture, and PCR until the treatment was complete.
The conversion rate for sputum culture, smear, and PCR at 8 weeks after treatment were 84.9, 58.5, and 47.1%, and at 16 weeks of treatment were 100, 88.7, and 79.2%, respectively. At the end of the treatment period, there were four PCR persisters, one of whom had disease relapse. Only cavitary disease had an influence over the negative conversion of the smear and PCR at 8 weeks (RR 3.5, 95% CI 1.04-11.95, P=0.04 for smear; RR 5.06, 95% CI 1.196-21.42, P=0.03 for PCR).
Qualitative PCR was not useful for monitoring therapy in smear-positive pulmonary tuberculosis. Mycobacterium DNA was cleared slowly in cavitary disease. The PCR may be performed at the time of treatment cessation to identify those with potential for disease relapse.
本研究旨在评估定性单管巢式聚合酶链反应（PCR）在监测涂片阳性肺结核治疗反应中的应用，以及治疗期间决定痰涂片、培养及PCR转阴的因素。
本研究纳入了53例接受标准短程化疗且在治疗停止后随访24个月的患者。在治疗结束前连续采集痰标本进行涂片、培养及PCR检测。
治疗8周时痰培养、涂片及PCR的转阴率分别为84.9%、58.5%和47.1%，治疗16周时分别为100%、88.7%和79.2%。在治疗期末，有4例PCR持续阳性患者，其中1例疾病复发。仅空洞性病变对8周时涂片及PCR转阴有影响（涂片：RR 3.5，95%CI 1.04-11.95，P=0.04；PCR：RR 5.06，95%CI 1.196-21.42，P=0.03）。
定性PCR在监测涂片阳性肺结核治疗中无应用价值。空洞性病变中结核分枝杆菌DNA清除缓慢。可在治疗停止时进行PCR检测以识别有疾病复发可能的患者。
