Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Usefulness of Automated PCR Test for the Detection of Mycobacterium Tuberculosis in Fresh Biopsy Tissues

신선조직 검체에서 결핵균 검출을 위한 자동화 중합효소연쇄반응 검사의 유용성

  • Choi, Woo Soon (Department of Laboratory Medicine, College of Medicine, The Catholic University) ;
  • Shin, So Young (Department of Laboratory Medicine, College of Medicine, The Catholic University) ;
  • Kim, Jong Ok (Department of Pathology, College of Medicine, The Catholic University) ;
  • Kim, Myung Sook (Department of Internal Medicine, College of Medicine, The Catholic University) ;
  • Lee, Hye Kyung (Department of Pathology, College of Medicine, The Catholic University)
  • 최우순 (가톨릭대학교 대전성모병원 진단검사의학과) ;
  • 신소영 (가톨릭대학교 대전성모병원 진단검사의학과) ;
  • 김종옥 (가톨릭대학교 대전성모병원 병리과) ;
  • 김명숙 (가톨릭대학교 대전성모병원 내과) ;
  • 이혜경 (가톨릭대학교 대전성모병원 병리과)
  • Received : 2006.05.11
  • Accepted : 2006.07.04
  • Published : 2006.07.30
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Abstract

Background: Although there have been several studies regarding the clinical value of an automated TB-PCR study using sputum, bronchial washing, and other body fluid samples for the detection of pulmonary tuberculosis, there are only a few reports on the use of fresh tissue samples. Materials and methods: The acid-fast bacilli stain(AFB), tuberculosis culture, automated TB-PCR study, and histopathology examination were performed in 42 fresh tissue samples. Results: Among the 42 cases, 18 cases were diagnosed with tuberculosis based on the clinical findings. Sixteen of the 18 cases were TB-PCR positive and of these 16 cases, only 2 cases were positive in the AFB stain or culture study. However, all 18 cases showed the histopathology findings of chronic granulomatous inflammation that was compatible with tuberculosis. Based on the clinical findings, the sensitivity, specificity, positive predictability, and negative predictability of the automated TB-PCR study were 88.9%, 100%, 100%, and 92.3% respectively. Conclusion: An automated TB-PCR assay is an important diagnostic tool for diagnosing tuberculosis in fresh tissue samples.

연구 배경 : 결핵의 대부분을 차지하는 폐결핵 진단에 객담, 기관지 세척액, 흉수액을 이용한 TB-PCR 검사의 유용성에 대해서는 여러 연구가 있었으나 폐 이외의 결핵 진단을 위한 신선 생검 조직 검체에서의 TB-PCR법 연구는 아직 미흡하다. 이에 저자들은 자동분석법인 COBAS AMPLICOR MTB PCR assay (Roche Molecular System)를 이용하여 신선 생검 조직 검체로 TB-PCR법의 유용성을 알아보았다. 방법 및 대상 : 2004년 10월부터 2005년 12월까지 가톨릭대학교 대전성모병원 병리과와 진단검사의학과에 결핵의진 하에 조직검사와 신선조직을 이용한 항산균 도말검사, 배양검사, TB-PCR 검사가 공히 의뢰된 환자 42예를 대상으로 하였다. 결 과 : 신선 생검 조직 42예를 대상으로 실시한 결과, 임상소견에서 결핵으로 진단된 경우는 18예 이었으며, 그 중 림프절 12예와 폐 조직 2예, 충수 조직 1예, 총 16예(88.9%)에서 PCR 양성을 보였고, 민감도와 특이도, 양성예측도, 음성 예측도는 88.9%, 100%, 100%와 92.3%로 나타났다. 조직학적으로 육아종 소견과 건락성 괴사의 소견 보인 18예(100%)는 모두 결핵으로 진단되었고 그 중 16예(88.9%)에서 PCR 양성을 보였다. 결 론 : 신선 생검 조직 검체를 이용한 TB-PCR 자동분석기의 결과는 임상소견 및 현미경적 소견과 비교 분석 시 민감도와 특이도가 높은 유용한 검사라고 생각되었다.

Keywords

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