摘要
目的了解荧光定量PCR(FQ-PCR)技术对前驱期(早期)小儿结核性脑膜炎(简称"结脑")的快速诊断、疗效观察和预后判断的作用和意义。方法选择被金标准(快速Mtb培养)确诊未经抗结核治疗的117例前驱期结脑组患儿和排除结脑的30例对照组患儿脑脊液标本,数字表法随机编号进行FQ-PCR检测Mtb DNA,计算其敏感度、特异度、诊断指数、阳性预测值、阴性预测值、符合率等统计指标并进行分析;治疗3周后结脑组盲法行培养和FQ-PCR检测,计算二者阳性检出率;随访出院时两种方法检测为阴性的结脑组患儿2年后各自复发率,进行统计学分析。结果初诊患儿FQ-PCR检测结果与金标准比较敏感度、特异度、符合率为100.0%(117/117)、96.7%(29/30)、99.3%(146/147),诊断指数达196.7%,经卡方检验,两者差异无统计学意义(χ2=0.000,P=1.000),相关性分析r=0.9790,两种方法间有相关性(χ2=140.9,P=0.000)。结脑组治疗3周后培养法和FQ-PCR法阳性检出率分别为27.35%(32/117)和58.12%(68/117),两者差异有统计学意义(χ2=22.63,P=0.000);随访结脑组患儿出院时两种方法检测阴性2年后复发结果为:78例培养法阴性患儿复发7例(8.97%),69例FQ-PCR检测阴性患儿未见复发患者,差异有统计学意义(χ2=4.6736,P=0.0306)。结论FQ-PCR检测脑脊液TB-DNA,准确、简便、快速,有助于早期诊断结脑,对疗效监测和预后评估比培养法更具优势。
Objective To explore the roles of FQ-PCR in rapid diagnosis,efficacy evaluation and prognosis for children tuberculous meningitis（TBM）. Methods A total of 147 patients of children were enrolled in the study,117 of whom were confirmed in prodromal stage TBM by the gold standard（culture with MGITTM 960） and the others（n=30） were control group without TBM.Cerebrospinal fluid（CSF）specimens of 147 cases were immediately numbered and detected by FQ-PCR and then the sensitivity（SE）,specificity（SP）,diagnostic index（DI）,positive predictive value（PPV）,negative predictive value（NPV）,agreement rate（AR） and other statistical indicators were calculate and analyzed.CSF of TBM group were cultured blindly and detected by FQ-PCR after 3 weeks and the two detection rate were calculated.Patients discharged from hospital who presented with negative by the two methods in the TBM group were followed up for 2 years and the recurrence rate was calculated. Results Compared to the gold standard,the SE,SP,DI and AR of FQ-PCR was 100.0%（117/117）,96.7%（29/30）,196.7%（116/117）,and 99.3%,respectively（χ2=0.000,P=1.000）.There was a correlation between the two methods（r=0.9790,χ2=140.9,P=0.000）.Thirty-two cases and 68 cases of the TBM group were detected by culture method and FQ-PCR after treatment for 3 weeks,respectively（χ2=22.63,P=0.000）.The follow-up results showed that 7 cases of 78 patients with negative culture result relapsed,69 patients with negative FQ-PCR had no recurrence,（χ2=4.6736,P=0.0306）. Conclusion FQ-PCR detection of cerebrospinal fluid TB-DNA is accurate,simple,rapid method,which can be used for early diagnosis of tuberculous meningitis,but also has advantages of prognosis monitoring and efficacy evaluation than the culture method.
出处
《中国防痨杂志》
CAS
2012年第5期280-283,共4页
Chinese Journal of Antituberculosis
关键词
结核
脑膜
聚合酶链反应
脑脊髓液
预后
Tuberculosis
meningeal
Polymerase chain reaction
Cerebrospinal fluid
Prognosis
