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Sensitivity of Polymerase Chain Reaction Reaction for Pleural Tuberculosis according to the Amount of Pleural Effusion Specimens

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2007, v.62 no.3, pp.184-191

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Abstract

연구 배경: 결핵성 흉막염의 진단에 있어서 흉수에 대한 중합효소연쇄반응 검사는 매우 낮은 민감도를 보였으며, 이는 흉수 내의 결핵균의 수가 적은 데에 기인하는 것으로 추정된다. 이번 연구에서는 흉수의 검체양을 증가시켰을 때 결핵성 흉수에 대한 중합효소연쇄반응 검사의 민감도가 향상되는지를 알아보고자 하였다. 방 법: 결핵성 흉막염에 대한 감별 진단이 필요하였던 53명의 환자에 대하여 전향적인 연구를 시행하였다. 각각의 환자로부터 얻은 흉수를 10 ml, 25 ml, 50 ml로 양을 달리 하여 결핵균에 대한 중합효소연쇄반응 검사를 시행하였으며, Cobas Amplicor MTB (Roche Diagnostic Systems)를 이용하였다. 결핵성 흉막염은 흉수에서 결핵균이 배양된 경우, 흉막 생검에서 결핵이 진단된 경우, 가래에서 결핵균이 배양된 경우 및 기타 원인이 배제된 상태에서 임상적으로 결핵성 흉수가 의심되며 항결핵제 투약으로 흉수가 호전된 경우를 포함하였다. 결 과: 53명의 환자 중 26명이 결핵성 흉막염으로 진단되었다. 흉수에 대한 항산균 바름질, 결핵균 배양, 아데노신 디아미나아제 측정 및 흉막 생검의 민감도는 각각 3.8%, 15.4%, 88.5%, 84.6%이었다. 10 ml, 25 ml, 50 ml의 흉수를 이용한 결핵균 중합효소연쇄반응 검사는 각각 3명(11.5%), 4명(15.4%), 3명(11.5%)에서 양성이었으며, 통계적으로 유의한 차이를 보이지 않았다(p>0.05, symmetry exact 검사). 결 론: 결핵균의 수가 극히 적을 것으로 예상되는 흉수 등의 검사물에 대해서는 결핵균 중합효소연쇄반응 검사의 임상적 유용성이 극히 제한적이며, 검사물의 양을 증가시키더라도 민감도는 향상되지 않는다. (Tuberc Respir Dis 2007; 62: 184-191)

keywords
Amplicor, Pleural effusion, Polymerase chain reaction (PCR), Sensitivity, Tuberculosis., Amplicor, Pleural effusion, Polymerase chain reaction (PCR), Sensitivity, Tuberculosis.

Reference

1.

(1997) Issues in the management of contacts of patients with active pulmonary tuberculosis,

2.

(1999) Transmission of Mycobacterium tuberculosis from patients smear- negative for acid-fast bacilli,

3.

(2000) Accuracy and utility of commercially available amplification and serologic tests for the diagnosis of minimal pulmonary tuberculosis,

4.

(1997) Differential diagnosis of tuberculous pleurisy by measurement of cytokine concentrations in pleural effusion,

5.

(2000) A clinician's guide to tuberculosis, Lippincott Williams & Wilkins

6.

(2000) Diagnostic standards and classification of tuberculosis in adults and children,

7.

(jclinmicrobiol1992;30) Detection of Mycobacterium tuberculosis in clinical samples by using polymerase chain reaction and a nonradioactive detection system, Schuitema AR

8.

A comparative study of the polymerase chain reaction and conventional procedures for the diagnosis of tuberculous pleural effusion, Maartens G

9.

(thorax1992;47) Detection of mycobacterial DNA in pleural fluid from patients with tuberculous pleurisy by means of the polymerase chain reaction comparison of two protocols,

10.

(1995) Rapid diagnosis of pleural tuberculosis by polymerase chain reaction,

11.

(2000) Evaluation of polymerase chain reaction, adenosine deaminase, and interferon-gamma in pleural fluid for the differential diagnosis of pleural tuberculosis,

12.

(2001) Evaluation of polymerase chain reaction for detection of Mycobacterium tuberculosis in pleural fluid,

13.

(2005) The clinical utility of polymerase chain reaction for the diagnosis of pleural tuberculosis,

14.

(1998) Laboratory Services in Tuberculosis Control, Geneva, Switzerland: World Health Organization

15.

Methods of enzyme analysis, Academic Press; 1983

16.

Pleural fluid and peripheral blood lymphocyte function in tuberculosis,

17.

(amrevtuberc1955;71) Operative and pathologic findings in twenty-four patients with syndrome of idiopathic pleurisy with effusion,

18.

(1996) From the Food and Drug Administration,

19.

(2000) From the Centers for Disease Control and Prevention,

20.

(2004) Molecular genetic methods for diagnosis and antibiotic resistance detection of mycobacteria from clinical specimens,

21.

(1996) Diagnosis of extrapulmonary tuberculosis by Gen-Probe amplified Mycobacterium tuberculosis direct test,

22.

(1996) Diagnostic performance of amplified Mycobacterium tuberculosis direct test with cerebrospinal fluid, other nonrespiratory, and respiratory specimens,

23.

(1995) Diagnostic value of an amplification method (Gen-Probe) compared with that of culture for diagnosis of tuberculosis,

24.

(1995) Diagnosis of tuberculosis by Amplicor Mycobacterium tuberculosis test: a multicenter study,

25.

(1998) Rapid diagnosis of tuberculosis in various biopsy and body fluid specimens by the AMPLICOR Mycobacterium tuberculosis polymerase chain reaction test,

26.

(2003) Four-year experience of use of the Cobas Amplicor system for rapid detection of Mycobacterium tuberculosis complex in respiratory and nonrespiratory specimens in Greece,

27.

(1998) Clinical evaluation of the automated COBAS AMPLICOR MTB assay for testing respiratory and nonrespiratory specimens,

28.

(2000) Detection of Mycobacterium tuberculosis in paraffin-embedded pleural biopsy specimens by commercial ribosomal RNA and DNA amplification kits,

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