應用重疊式聚合脢連鎖反應診斷結核腦膜炎

Diagnosis of Tuberculous Meningitis by a Nested Polymerase Chain Reaction

應用重疊式聚合脢連鎖反應技術，我們回顧性檢測結核桿菌去氧核醣核酸（簡稱DNA）於100個腦脊髓液檢體，其中26個檢體來自結核性腦膜炎病患，其餘74個檢體為對照組。結果顯示：重疊式聚合脢連鎖反應可從26位結核性腦膜炎患者中21位之腦脊髓液中成功偵測出結核桿菌DNA，而74位對照組的腦脊髓液均為陰性。在這21位陽性患者中，3位之腦脊髓液同時成功培養出結核桿菌，但其餘79位陰性患者其腦脊髓液均無法培養出結核桿菌。此外，在這100份檢體中，結核桿菌的快速染色均為陰性。因此，應用重疊式聚合脢連鎖反應診斷結核性腦膜炎的敏感性為81%，而特異性為100%。結論：重疊式聚合脢連鎖反應為作為臨床上快速且正確診斷結核性腦膜炎的方法。

We retrospectively applied nested polymerase chain reaction (PCR) to detect Mycobacterium tuberculosis DNA in 100 cerebrospinal fluid (CSF) samples from 26 patients with clinically diagnosed tuberculous meningitis (TB meningitis) and 74 controls. The result revealed that PCR could detect Mycobacterium tuberculosis DNA in 21 of the 26 TB meningitis patients, while the 74 controls were all negative. In those 21 PCR-positive patients, 3 also had a positive mycobacterial culture, but the cultures were all negative in PCR-negative patients. The acid-fast bacillus (AFB) stains by direct smear were all negative for all 100 CSF samples. The sensitivity and specificity of nested PCR for the diagnosis of TB meningitis in this study were 81% and 100%, respectively. Furthermore, all procedures of the nested amplification, protocol were completed within 6-8 hours. In conclusion, the nested PCR assay is useful for rapid and accurate diagnosis of TB meningitis.