聚合酶链反应检测结核分枝杆菌 DNA 在关节结核诊断中的临床价值。

Clinical value of polymerase chain reaction in the diagnosis of joint tuberculosis by detecting the DNA of Mycobacterium tuberculosis.

机构信息

Second Department of Arthrosis, Wangjing Hospital, China Academy of Chinese Medicine, Henan, China.

出版信息

Orthop Surg. 2011 Feb;3(1):64-71. doi: 10.1111/j.1757-7861.2010.00115.x.

DOI:10.1111/j.1757-7861.2010.00115.x

PMID:22009983

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6583303/

Abstract

OBJECTIVE

To assess the clinical value of polymerase chain reaction (PCR) in the diagnosis and differential diagnosis of joint tuberculosis (TB).

METHODS

PCR was used blindly to detect the DNA of Mycobacterium tuberculosis (M.TB) in five specimens of M.TB, 5 of BCG, and 10 of other bacteria. Then, M. TB in 98 samples from patients with joint TB and 100 samples from patients with non-tubercular joint disorders were detected by PCR, acid-fast staining and culture,. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PCR were calculated. The χ2 test was used for statistical analysis of the frequency of various factors. At the same time, some problems with PCR were also systematically analyzed.

RESULTS

(1) In the "standard samples", both M. TB and BCG showed positive while other bacteria were negative. (2) In 98 cases from patients with joint TB, 81 were positive by PCR, 6 by acid-fast staining, and 17 by culture. In 100 cases from patients with non-tuberculous joint disorders, 9 were positive by PCR, and none by either acid-fast staining or culture. Sensitivity, specificity, accuracy, positive and negative predictive value of PCR were 82.65% (81/98), 91.00% (91/100), 86.87% (172/198), 90.00% (81/90) and 84.26% (91/108), respectively. (3) The positive rates for PCR, acid-fast staining and culture in detection of M. TB were 82.65% (81/98), 6.12% (6/98), and 17.34% (17/98), respectively. There were statistically significant differences between the three methods (P < 0.001). (4) The process of PCR is automatic, and can be completed within 3 to 6 hours, whereas 4 to 8 weeks are required for the conventional culture of M. TB.

CONCLUSION

PCR is a sensitive, specific, rapid, simple and minimally invasive method for detection of M. TB in samples from joint TB, and can play an important role in early and rapid diagnosis and differential diagnosis of joint TB. But it also has some limitations, such as false positivity and false negativity.

摘要

目的

评估聚合酶链反应（PCR）在关节结核（TB）诊断和鉴别诊断中的临床价值。

方法

采用盲法对 5 例结核分枝杆菌（M.TB）、5 例卡介苗（BCG）和 10 例其他细菌标本进行 PCR 检测，然后采用 PCR、抗酸染色和培养法检测 98 例关节结核患者和 100 例非结核性关节疾病患者的 M.TB。计算 PCR 的敏感性、特异性、准确性、阳性预测值和阴性预测值。采用 χ2 检验对各因素频率进行统计学分析。同时，系统分析了 PCR 的一些问题。

结果

（1）在“标准样本”中，M.TB 和 BCG 均为阳性，而其他细菌均为阴性。（2）98 例关节结核患者中，PCR 阳性 81 例，抗酸染色阳性 6 例，培养阳性 17 例；100 例非结核性关节疾病患者中，PCR 阳性 9 例，抗酸染色和培养均为阴性。PCR 的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为 82.65%（81/98）、91.00%（91/100）、86.87%（172/198）、90.00%（81/90）和 84.26%（91/108）。（3）PCR、抗酸染色和培养检测 M.TB 的阳性率分别为 82.65%（81/98）、6.12%（6/98）和 17.34%（17/98），三种方法差异有统计学意义（P<0.001）。（4）PCR 过程自动，3～6 小时内即可完成，而结核分枝杆菌的常规培养则需要 4～8 周。