Department of Microbiology and Clinical Microbiology, Medical Faculty, Kocaeli University, 41380 Kocaeli, Turkey.
Am J Med Sci. 2010 Mar;339(3):244-8. doi: 10.1097/MAJ.0b013e3181cbfe40.
Nucleic acid amplification tests to detect Mycobacterium tuberculosis in clinical specimens are used increasingly as a laboratory tool. We aimed to investigate the routine using pattern and the effects on therapeutic decision of diagnostic tests for tuberculosis in our hospital.
In this descriptive study, we investigated retrospectively the routine using pattern and the effects on therapeutic decision of diagnostic tests for tuberculosis. Patients with discordant results were clinically evaluated retrospectively by a chest physician. Samples were tested for the presence of M. tuberculosis by a smear technique, M. tuberculosis culture growth technique (Löwenstein-Jensen and/or BACTEC-960), and IS6110 polymerase chain reaction (PCR).
Culture positivity was 7.2% (83 of 1159 patients). In total, 198 (62.4%) were tested with PCR, acid-fast bacilli, and culture. On the basis of culture results as a gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of PCR were 46%, 89%, 23%, and 93.5%, respectively.
Selection of appropriate patients for further testing and exclusion of low-risk patients from microbiologic testing by experienced clinicians may help to optimize the positive predictive value of PCR.
检测临床标本中的结核分枝杆菌的核酸扩增测试已越来越多地被用作实验室工具。我们旨在研究我们医院中结核病诊断测试的常规使用模式及其对治疗决策的影响。
在这项描述性研究中，我们回顾性地调查了结核病诊断测试的常规使用模式及其对治疗决策的影响。通过胸部医师对结果不一致的患者进行回顾性临床评估。通过涂片技术、结核分枝杆菌培养生长技术（Löwenstein-Jensen 和/或 BACTEC-960）和 IS6110 聚合酶链反应（PCR）检测样本中是否存在 M. tuberculosis。
培养阳性率为 7.2%（1159 例患者中的 83 例）。共有 198 例（62.4%）接受了 PCR、抗酸杆菌和培养检测。根据培养结果作为金标准，PCR 的灵敏度、特异性、阳性预测值和阴性预测值分别为 46%、89%、23%和 93.5%。
选择合适的患者进行进一步检测，并由经验丰富的临床医生排除低风险患者进行微生物学检测，可能有助于优化 PCR 的阳性预测值。
