Alcantara-Payawal D E, Matsumura M, Shiratori Y, Okudaira T, Gonzalez R, Lopez R A, Sollano J D, Omata M
Department of Internal Medicine (II), Faculty of Medicine, University of Tokyo, Japan.
J Hepatol. 1997 Oct;27(4):620-7. doi: 10.1016/s0168-8278(97)80078-5.
In liver tuberculosis, demonstration of acid bacilli by conventional methods remains futile. Since the definitive diagnosis of liver tuberculosis is based on the histologic evidence of granulomatous process with caseation necrosis, seen in only a third of cases, the diagnosis is made retrospectively by response to empirical anti-tuberculous drug therapy.
Our objective is to establish a polymerase chain reaction assay for detection of Mycobacterium tuberculosis affecting the liver using the paraffin-embedded liver biopsy specimens obtained from patients with hepatic granulomas.
As positive control, patients having either "definitive" (n=8) or "presumptive" (n=9) tuberculosis on the basis of clinical, microbiological, histologic data and their positive response to empirical treatment of anti-tuberculous drugs were used. Patients with hepatic granulomas secondary to schistosomiasis (n=6), sarcoidosis (n=2) and other liver diseases (n=10) were used as negative control.
Of those patients who were diagnosed as having "definitive" and "presumptive" liver tuberculosis, positivity by one-step polymerase chain reaction was 100% and 44%, respectively. Using the nested polymerase chain reaction, positivity increased to 78% with "presumptive" liver tuberculosis. In contrast, the polymerase chain reaction assays were negative among all patients with hepatic granuloma due to non-tuberculous-in-origin and other liver diseases.
The overall positivity of this polymerase chain reaction assay (88%) compares favorably with that of other conventional methods (12%). Thus, this polymerase chain reaction assay may be a reliable diagnostic tool for liver tuberculosis in a patient population in which the prevalence of diseases associated with hepatic granuloma is common.
在肝结核中，通过传统方法证明抗酸杆菌仍然没有效果。由于肝结核的确诊基于仅在三分之一病例中可见的伴有干酪样坏死的肉芽肿性病变的组织学证据，因此通过对抗结核药物经验性治疗的反应进行回顾性诊断。
我们的目标是建立一种聚合酶链反应检测方法，用于检测从肝肉芽肿患者获得的石蜡包埋肝活检标本中影响肝脏的结核分枝杆菌。
作为阳性对照，使用基于临床、微生物学、组织学数据以及对抗结核药物经验性治疗的阳性反应而患有“确诊”（n = 8）或“推定”（n = 9）结核病的患者。将血吸虫病（n = 6）、结节病（n = 2）和其他肝病（n = 10）继发的肝肉芽肿患者用作阴性对照。
在那些被诊断为患有“确诊”和“推定”肝结核的患者中，一步聚合酶链反应的阳性率分别为100%和44%。使用巢式聚合酶链反应，“推定”肝结核的阳性率升至78%。相比之下，所有非结核源性肝肉芽肿和其他肝病患者的聚合酶链反应检测均为阴性。
这种聚合酶链反应检测的总体阳性率（88%）优于其他传统方法（12%）。因此，在与肝肉芽肿相关疾病患病率较高的患者群体中，这种聚合酶链反应检测可能是肝结核的可靠诊断工具。
