São José do Rio Preto School of Medicine, São José do Rio Preto, Brazil.
Adolfo Lutz Institute, Department of Mycobacteria, São José do Rio Preto, Brazil.
J Bras Pneumol. 2013 Nov-Dec;39(6):711-8. doi: 10.1590/S1806-37132013000600010.
To compare the performance of nested polymerase chain reaction (NPCR) with that of cultures in the detection of the Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens.
We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively, of 67 hospitalized patients suspected of having tuberculosis. An automated microbial system was used for the identification of Mycobacterium spp. cultures, and M. tuberculosis IS6110 was used as the target sequence in the NPCR. The kappa statistic was used in order to assess the level of agreement among the results.
Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary and extrapulmonary tuberculosis, and the NPCR was positive in all of the cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the results of NPCR with those of cultures (the gold standard), we found that NPCR had a sensitivity and specificity of 100% and 83%, respectively, in pulmonary specimens, compared with 83% and 96%, respectively, in extrapulmonary specimens, with good concordance between the tests (kappa, 0.50 and 0.6867, respectively).
Although NPCR proved to be a very useful tool for the detection of M. tuberculosis complex, clinical, epidemiological, and other laboratory data should also be considered in the diagnosis and treatment of pulmonary and extrapulmonary tuberculosis.
比较巢式聚合酶链反应（NPCR）与培养法在检测肺部和肺外标本中的结核分枝杆菌复合群的性能。
我们分析了分别来自 67 例疑似患有结核病的住院患者的 20 份肺部和 78 份肺外标本。使用自动化微生物系统对分枝杆菌属培养物进行鉴定，并且在 NPCR 中使用 M. tuberculosis IS6110 作为靶序列。使用 Kappa 统计量评估结果之间的一致性水平。
在 67 例患者中，分别有 6 例和 5 例被诊断为肺部和肺外结核，并且所有病例的 NPCR 均为阳性。在 98 份临床标本中，涂片显微镜检查、培养和 NPCR 的阳性率分别为 6.00%、8.16%和 13.26%。将 NPCR 与培养（金标准）的结果进行比较，我们发现 NPCR 在肺部标本中的敏感性和特异性分别为 100%和 83%，而在肺外标本中的敏感性和特异性分别为 83%和 96%，两种检测方法具有良好的一致性（kappa 值分别为 0.50 和 0.6867）。
尽管 NPCR 被证明是检测结核分枝杆菌复合群的非常有用的工具，但在诊断和治疗肺部和肺外结核病时，还应考虑临床、流行病学和其他实验室数据。
