肺外结核：尿液中16S - rRNA的鉴别要点及作用

Extra-pulmonary tuberculosis: differential aspects and role of 16S-rRNA in urine.

作者信息

Fortún J, Martín-Dávila P, Gómez-Mampaso E, González-García A, Barbolla I, Gómez-García I, Wikman P, Ortíz J, Navas E, Cuartero C, Gijón D, Moreno S

机构信息

Infectious Diseases Department Ramon y Cajal Hospital, Madrid, Spain.

Infectious Diseases Department, Ramon y Cajal Hospital, Madrid, Spain.

出版信息

Int J Tuberc Lung Dis. 2014 Apr;18(4):478-85. doi: 10.5588/ijtld.13.0555.

DOI:10.5588/ijtld.13.0555

PMID:24670706

Abstract

BACKGROUND

Early diagnosis of extra-pulmonary tuberculosis (EPTB) is important for successful treatment.

METHODS

All cases of EPTB diagnosed at Ramon y Cajal Hospital, Madrid, Spain, from 1997 to 2008 were analysed and compared with pulmonary tuberculosis (PTB) patients to identify differential parameters that could serve to predict the presence of EPTB at initial presentation. Different microbiological techniques were analysed, including amplification of 16S-rRNA in urine.

RESULTS

During the study period, 814 cases of TB were diagnosed at our centre; 330 (40.5%) were EPTB. Concomitant PTB was detected in 45% of EPTB cases. The main clinical forms of EPTB were lymphadenitis (86, 26%), miliary TB (60, 18%), and multifocal TB (43, 13%). Variables independently associated with EPTB were human immunodeficiency virus (HIV) infection (OR 3.6, 95%CI 2.4-5.4), older age (>60 years) (OR 3.7, 95%CI 2.5-5.6) and mortality (OR 2.9, 95%CI 1.3-6.3). 16S-rRNA in urine was performed in 82 EPTB patients (25%), among whom a positive result was obtained in 70%; in the PTB group, a positive result was found in 5 of 28 patients (18%) (P <0.001).

CONCLUSIONS

HIV infection and older age appear to be the main risk factors associated with EPTB. In this study, mortality was significantly higher in patients with EPTB. A positive 16S-rRNA test result in urine is a useful marker of EPTB.

摘要

背景

肺外结核病（EPTB）的早期诊断对成功治疗至关重要。

方法

对1997年至2008年在西班牙马德里拉蒙·伊·卡哈尔医院诊断出的所有EPTB病例进行分析，并与肺结核（PTB）患者进行比较，以确定可用于预测初诊时EPTB存在的鉴别参数。分析了不同的微生物学技术，包括尿液中16S - rRNA的扩增。

结果

在研究期间，我们中心诊断出814例结核病；330例（40.5%）为EPTB。45%的EPTB病例中检测到合并PTB。EPTB的主要临床形式为淋巴结炎（86例，26%）、粟粒性结核（60例，18%）和多灶性结核（43例，13%）。与EPTB独立相关的变量有人免疫缺陷病毒（HIV）感染（比值比[OR] 3.6，95%置信区间[CI] 2.4 - 5.4））、老年（>60岁）（OR 3.7，95%CI 2.5 - 5.6）和死亡率（OR 2.9，95%CI 1.3 - 6.3）。82例（25%）EPTB患者进行了尿液16S - rRNA检测，其中70%结果为阳性；在PTB组，28例患者中有5例（18%）结果为阳性（P <0.001）。