Kolk A H, Kox L F, van Leeuwen J, Kuijper S, Jansen H M
Dept of Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands.
Eur Respir J. 1998 Jun;11(6):1222-6. doi: 10.1183/09031936.98.11061222.
This study examines the diagnostic utility of the polymerase chain reaction (PCR) in 156 patients (five human immunodeficiency virus (HIV) seropositive) suspected of extrapulmonary tuberculosis. The results of PCR in 226 samples from 11 different sites were compared with the results of microscopy and culture. Positive culture results were predicted in 86% of samples by PCR but in only 31% by microscopy. Specificity of PCR was 92%. In cases with culture-proven tuberculosis, PCR identified all 11 microscopy positive cases and 19 of 24 (79%) of the microscopy-negative cases. In four patients, PCR excluded the diagnosis of tuberculosis in microscopy-positive samples, which were later shown to contain mycobacteria other than Mycobacterium tuberculosis or laboratory contaminants. In 20 patients (microscopy, PCR and culture negative) a trial of antituberculous drugs was given, but patients showed no improvement and treatment was stopped. In 17 patients, all culture negative (in nine PCR was positive, three of whom also had positive microscopy) the diagnosis was probable tuberculosis based on clinical findings and response to treatment. This polymerase chain reaction has a much higher sensitivity than microscopy and can facilitate therapeutic decisions for those with suspected extrapulmonary tuberculosis.
本研究检测了聚合酶链反应（PCR）在156例疑似肺外结核患者（5例人类免疫缺陷病毒（HIV）血清学阳性）中的诊断效用。将来自11个不同部位的226份样本的PCR结果与显微镜检查和培养结果进行了比较。PCR对86%的样本培养结果呈阳性做出了预测，而显微镜检查仅为31%。PCR的特异性为92%。在培养确诊为结核病的病例中，PCR识别出了所有11例显微镜检查阳性病例以及24例显微镜检查阴性病例中的19例（79%）。在4例患者中，PCR排除了显微镜检查阳性样本的结核病诊断，这些样本后来被证明含有非结核分枝杆菌或实验室污染物。在20例患者（显微镜检查、PCR和培养均为阴性）中进行了抗结核药物试验，但患者无改善，治疗停止。在17例患者中，所有培养均为阴性（9例PCR为阳性，其中3例显微镜检查也为阳性），根据临床发现和治疗反应，诊断为可能的结核病。这种聚合酶链反应的敏感性比显微镜检查高得多，可为疑似肺外结核患者的治疗决策提供帮助。
