Cegielski J P, Devlin B H, Morris A J, Kitinya J N, Pulipaka U P, Lema L E, Lwakatare J, Reller L B
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Clin Microbiol. 1997 Dec;35(12):3254-7. doi: 10.1128/jcm.35.12.3254-3257.1997.
Nucleic acid amplification techniques for the diagnosis of tuberculosis (TB) are rapidly being developed. Scant work, however, has focused on pericardial TB. Using cryopreserved specimens from a prior study of pericarditis, we compared PCR to culture and histopathology for the diagnosis of tuberculous pericarditis in 36 specimens of pericardial fluid and 19 specimens of pericardial tissue from 20 patients. Fluid and tissue were cultured on Lowenstein-Jensen and Middlebrook solid media and in BACTEC radiometric broth. Tissue specimens were stained with hematoxylin-eosin, Ziehl-Neelsen, auramine O, and Kinyoun stains and were examined for granuloma formation and acid-fast bacilli. PCR was performed with both fluid and tissue with IS6110-based primers specific for the Mycobacterium tuberculosis complex by published methods. Sixteen of the 20 patients had tuberculous pericarditis and 4 patients had other diagnoses. TB was correctly diagnosed by culture in 15 (93%) patients, by PCR in 13 (81%) patients, and by histology in 13 of 15 (87%) patients. PCR gave one false-positive result for a patient with Staphylococcus aureus pericarditis. Considering the individual specimens as the unit of analysis, M. tuberculosis was identified by culture in 30 of 43 specimens (70%) from patients with tuberculous pericarditis and by PCR in 14 of 28 specimens (50%) from patients with tuberculous pericarditis (P > 0.15). The sensitivity of PCR was higher with tissue specimens (12 of 15; 80%) than with fluid specimens (2 of 13; 15%; P = 0.002). In conclusion, the overall accuracy of PCR approached the results of conventional methods, although PCR was much faster. Therefore, PCR merits further development in this regard. The sensitivity of PCR with pericardial fluid was poor, and false-positive results with PCR remain a concern.
用于诊断结核病（TB）的核酸扩增技术正在迅速发展。然而，针对心包结核的研究工作却很少。我们利用先前一项心包炎研究中冷冻保存的标本，对20例患者的36份心包积液标本和19份心包组织标本进行了结核性心包炎诊断的PCR检测，并与培养及组织病理学方法进行了比较。将积液和组织分别接种于罗-琴和Middlebrook固体培养基以及BACTEC放射性肉汤中培养。组织标本进行苏木精-伊红、萋-尼、金胺O及金扬染色，检查肉芽肿形成及抗酸杆菌情况。按照已发表的方法，使用针对结核分枝杆菌复合群的基于IS6110的引物对积液和组织进行PCR检测。20例患者中16例患有结核性心包炎，4例为其他诊断。通过培养正确诊断出15例（93%）结核患者，PCR诊断出13例（81%），组织病理学在15例中的13例（87%）诊断正确。PCR对1例金黄色葡萄球菌心包炎患者给出了1例假阳性结果。以单个标本作为分析单位，结核性心包炎患者的43份标本中30份（70%）通过培养鉴定出结核分枝杆菌，28份标本中14份（50%）通过PCR鉴定出结核分枝杆菌（P>0.15）。PCR对组织标本的敏感性（15例中的12例；80%）高于积液标本（13例中的2例；15%；P=0.002）。总之，尽管PCR速度快得多，但其总体准确性接近传统方法的结果。因此，PCR在这方面值得进一步发展。PCR对心包积液的敏感性较差，且PCR的假阳性结果仍是一个问题。
