Chen N H, Liu Y C, Tsao T C Y, Wu T L, Hsieh M J, Chuang M L, Huang C C, Kuo A J, Chen M C, Yang C T
Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
Int J Tuberc Lung Dis. 2002 Apr;6(4):350-5.
The polymerase chain reaction (PCR) may be sensitive and specific for the diagnosis of tuberculosis, but most reports are of studies conducted in well-controlled laboratories. A study to evaluate the clinical value of bronchoalveolar lavage (BAL) combined with PCR was necessary.
One hundred and thirty one patients were recruited into the study from March 1994 to February 1997.
Patients with a positive acid-fast stain on sputum smear were recruited into group A as positive controls, patients with lung cancer and a negative acid-fast stain on sputum smear were put into group B as negative controls, and patients who had clinical symptoms of pulmonary TB without sputum or with negative smear results were the investigating group. PCR was performed on the sputum samples from group A and B patients and on the BAL fluid from those in group C.
The sensitivity of PCR was 96% in group A, and the specificity was 100% in group B. The sensitivity of PCR in the BAL fluid from the group C patients was 36% and the specificity was 96%; the positive predictive value was 94% and the negative predictive value was 45%.
BAL plus PCR is useful in the rapid diagnosis of pulmonary TB in non-productive or smear-negative patients.
聚合酶链反应（PCR）在结核病诊断中可能具有敏感性和特异性，但大多数报告是关于在严格控制的实验室中进行的研究。有必要开展一项评估支气管肺泡灌洗（BAL）联合PCR临床价值的研究。
1994年3月至1997年2月，131名患者被纳入该研究。
痰涂片抗酸染色阳性的患者被纳入A组作为阳性对照，肺癌且痰涂片抗酸染色阴性的患者被放入B组作为阴性对照，有肺结核临床症状但无痰或涂片结果为阴性的患者为研究组。对A组和B组患者的痰样本以及C组患者的BAL液进行PCR检测。
A组中PCR的敏感性为96%，B组中特异性为100%。C组患者BAL液中PCR的敏感性为36%，特异性为96%；阳性预测值为94%，阴性预测值为45%。
BAL联合PCR有助于对无痰或涂片阴性患者的肺结核进行快速诊断。
