BALF 中 TB-PCR 与涂片阴性活动性肺结核的耐药模式。

TB-PCR and drug resistance pattern in BALF in smear-negative active pulmonary TB.

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Microbiology Laboratory, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Int J Tuberc Lung Dis. 2017 Dec 1;21(12):1294-1299. doi: 10.5588/ijtld.17.0326. Epub 2017 Oct 9.

DOI:10.5588/ijtld.17.0326

PMID:28992819

Abstract

SETTING

A tertiary referral hospital in Bangkok, Thailand.

OBJECTIVES

To evaluate the efficacy of a bronchoalveolar lavage fluid (BALF) tuberculosis (TB) polymerase chain reaction (PCR) assay for the diagnosis of sputum smear-negative pulmonary TB (PTB) and the usefulness of a drug-resistant (DR) TB-PCR assay compared with standard drug susceptibility testing (DST).

DESIGN

BALF samples from 918 patients with acid-fast bacilli (AFB) negative sputum smears who underwent bronchoscopy for diagnostic evaluations of pulmonary diseases were prospectively determined for specific genetic elements of TB using the AnyplexTM MTB/NTM Real-Time Detection kit. Positive TB-PCR samples were subsequently evaluated for DR-TB using the Anyplex II MTB/MDR Detection kit.

RESULTS

A total of 224 patients were finally diagnosed with PTB. The sensitivity, specificity, positive predictive value and negative predictive value of the TB-PCR assay were respectively 38.8%, 100%, 100%, and 83.5%. The TB-PCR assay was more sensitive than culture (30.4%) and smear (6.7%). Of the 68 TB-positive culture samples, three cases with either isoniazid (INH) or rifampicin (RMP) resistance were detected by DST. The Anyplex II MTB/MDR assay provided similar results.

CONCLUSIONS

The BALF TB-PCR assay is a useful tool in the diagnosis of sputum smear-negative PTB. It can also provide INH and RMP susceptibility patterns similar to those of standard DST.

摘要

背景

泰国曼谷的一家三级转诊医院。

目的

评估支气管肺泡灌洗液（BALF）结核（TB）聚合酶链反应（PCR）检测在诊断痰涂片阴性肺结核（PTB）中的疗效，并比较耐药性（DR）TB-PCR 检测与标准药敏试验（DST）相比的用途。

设计

前瞻性地对 918 例因肺部疾病而行支气管镜检查的抗酸杆菌（AFB）阴性痰涂片患者的 BALF 样本进行特定的 TB 基因元件检测，使用 AnyplexTM MTB/NTM Real-Time Detection 试剂盒。阳性 TB-PCR 样本随后使用 Anyplex II MTB/MDR Detection 试剂盒进行 DR-TB 评估。

结果

共 224 例患者最终被诊断为 PTB。TB-PCR 检测的灵敏度、特异性、阳性预测值和阴性预测值分别为 38.8%、100%、100%和 83.5%。TB-PCR 检测比培养（30.4%）和涂片（6.7%）更敏感。在 68 例 TB 阳性培养样本中，DST 检测到三种异烟肼（INH）或利福平（RMP）耐药的病例。Anyplex II MTB/MDR 检测也提供了类似的结果。