聚合酶链反应检测结核分枝杆菌DNA诊断关节结核的临床评价

Clinical evaluation of polymerase chain reaction in the diagnosis of joint tuberculosis by detecting DNA of Mycobacterium tuberculosis

目的评价聚合酶链反应（polymerase chain reaction,PCR）检测关节结核标本结核分枝杆菌脱氧核糖核酸（deoxyribonucleic acid,DNA）诊断关节结核的临床价值。方法对20份标准标本（5份结核分枝杆菌标准菌株、5份卡介苗和10份其它细菌标本）分别应用PCR盲法检测结核分枝杆菌DNA。对95例关节结核标本和98例非关节结核标本分别应用PCR检测结核分枝杆菌DNA。应用疾病诊断方法的临床评价原则对PCR诊断关节结核的敏感性、特异性和准确性进行评价。结果 （1）20份标准标本PCR检测中,结核分枝杆菌和卡介苗均为阳性,而其它细菌均为阴性;（2）95例关节结核标本中,PCR阳性78例、阴性17例;98例非关节结核标本中,PCR阳性9例、阴性89例;（3）PCR检测关节结核标本结核分枝杆菌DNA的敏感性为82.11%、特异性为90.81%、准确性为86.60%、阳性预测值为89.80%、阴性预测值为84.00%;（4）PCR整个检测过程自动化控制,可在3~6h内完成。结论 PCR是一种敏感、特异、快速、简便、无创、标本微量的关节结核标本结核分枝杆菌检测方法,对于关节结核的早期、快速诊断与鉴别诊断具有极其重要的临床价值。

Objective To study the role of（polymerase chain reaction PCR）technique in detection of（deoxyribonucleic acid DNA）of Mycobacterium tuberculosis in the samples from joint tuberculosis,and to appraise its clinical value in diagnosis of joint tuberculosis.Methods PCR technique was used to detect blindly DNA of Mycobacterium tuberculosis in 20 standard specimens（5 specimens of Mycobacterium tuberculosis,5 BCG,and 10 other bacteria.）Then,it was used respectively to detect DNA of Mycobacterium tuberculosis in specimens obtained from 95 patients with joint tuberculosis and 98 ones with non-tubercular joint disorders.The clinical evaluation was preformed according to evaluation principle on diagnosis methods based on clinical epidemiology.Results（1）In detection of the standard samples,both Mycobacterium tuberculosis and BCG showed positive,and all the other bacteria negative.（2）In 95 cases of joint tuberculosis,PCR was positive in 78 and negative in 17.In 98 cases of non-tubercular joint disorders,9 cases showed positive,and the others negative.In aspect of detecting DNA of Mycobacterium tuberculosis in specimens of joint tuberculosis,sensitivity of PCR technique was 82.11%,specificity was 90.81%,accuracy was 86.60%,positive predictive value was 89.80%,and negative predictive value was 84.00%.（3）The whole process of PCR amplification was automatic and could be finished within 3 to 6 hours.Conclusions PCR technique is a sensitive,specific,rapid,simple,minimal invasive and sample-microcrystalline method for detection of Mycobacterium tuberculosis in the samples from joint tuberculosis,and it plays a very important role in the early and rapid diagnosis and differential diagnosis of joint tuberculosis.