Polymerase Chain Reaction Examination of Urine for Rapid Detection of Mycobacterium Tuberculosis in the Genitourinary Tract

利用多聚合酵素連鎖反應技術快速偵測尿液中結核桿菌之存在

張聖原(Sun-Yran Chang) ； 于大雄(Dah-Shyong Yu)

《中華民國泌尿科醫學會雜誌》 12卷1期 (2001/03) Pp. 24-31

https://doi.org/10.7024/JUAROC.200103.0024

摘要

研究目的：本研究建立適用之聚合酵素連鎖反應技術（PCR）來檢查尿液及泌尿道切除組織，以期及早發現結核菌之存在。
材料與方法：利用三種探子（MPB-nested PCR, INS, Pt）以聚合酵素連鎖反應技術方法共分析50例尿液標本（12例確定尿路結核者，19例疑似尿路結核者，19例一般細菌性尿路感染者），2例經皮分泌物，3例切除之組織。
結果：結果顯示MPB-nested PCR,INS,Pt三者對診斷結核之陽性率分別是在確定為尿路結核者（正確陽性率）為88.3%、75.0%、41.7%；疑似尿路結核者（診斷發生率）分別為31.6%、42.1%、26.3%，而對一般細菌性尿路感染者陽性率（假性陽性率，false-positive rate）分別是15.8%、36.8%、10.5%。MPB-nested PCR方法有最高之尿液結核診斷率，尚可接受之假性陽性率；而INS二方面皆高，並不理想；Pt探子假性陽性率最低，但正確陽性率偏低。在17例從事尿液結核菌染色抹片與細菌培養之標本中，分別僅1例（11.8%）抹片及培養呈陽性。四位確定為尿路結核者經抗結核藥物治療後之尿液均仍會出現持續性的PCR陽性反應。
結論:這些結果將促使我們日後利用MPB-nested PCR技術改進對泌尿道結核菌感染之早期診斷，並間接改善病人治療之預後

關鍵字

多聚合酵素連鎖反應 ； 結核桿菌 ； 泌尿道 ； 尿液

並列摘要

OBJECTIVE: For rapid detection of Mycobacterium tuberculosis existence in the genitourinary tract a polymerase chain reaction was established to examine urine bacteria.
MATERIALS AND METHODS: By using 3 DNA primers (MPB, INS, and Pt)and the PCR method, totally 50 specimens of urine(12 cases of definitive TB, 19 cases of suspicious TB, and 19 cases of ordinary UTI), 2 specimens of local discharge, and 3 specimens of resected tissues were analyzed.
RESULTS: The positive detection rates of the 3 DNA primers, MPB, INS, and Pt, in definitive TB patients(true-positive rate)were 88.3%, 75.0%, and 41.7%; in suspicious TB patients(diagnostic rate)were 31.6%, 42.1%, and 26.3%; and in UTI patients(false-positive rate)were 15.8%, 36.8%, and 10.5%. MBP-nested PCR had the highest diagnostic power for TB infection in urine with an acceptable false-positive rate. The INS probe is not suitable for detection because both its high true-and false-positive rate were high, while the Pt probe had the lowest false-positive rate but also a low true- positive rate. Only l out of 17 cases (11.8%) showed a positive smear examination and TB culture, respectively. Interestingly, 4 patients after anti-TB triple therapy still had a positive PCR reaction in their urine.
CONCLUSIONS: These results provide us with an early diagnosis of M. tuberculosis infection in the genitourinary tract which can improve the treatment outcome of patients by using MPB-nested PCR. However, more-sensitive primers should be developed in the future for increasing the diagnostic rate.

並列關鍵字

polymerase chain reaction(PCR) ； Mycobacterium tuberculosis ； genitourinary tract ； urine