PCR法检测结核分枝杆菌DNA在鉴别克罗恩病与肠结核中的价值  

Feasibility of polymerase chain reaction for detecting Mycobacterium tuberculosis DNA in differential diagnosis of intestinal tuberculosis and Crohn disease

作　　者：陈瑜君[1] 何瑶[1] 陈白莉[1] 毛仁[1] 晁康[1] 徐萍萍[1] 曾志荣[1] 陈旻湖[1] 胡品津[1] 

机构地区：[1]中山大学附属第一医院消化内科,广东广州510080

出　　处：《中国病理生理杂志》2013年第1期188-192,共5页Chinese Journal of Pathophysiology

基　　金：卫生部卫生行业基金(No.201002020);广东省科技计划项目(No.2010B031600044);广东省自然科学基金资助项目(No.S2011010004333)

摘　　要：目的:评估聚合酶链反应(PCR)技术检测通过活检或手术获取的肠道组织石蜡标本中结核分枝杆菌(Mycobacterium tuberculosis,MTB)DNA在鉴别克罗恩病(Crohn disease,CD)和肠结核(intestinal tuberculosis,ITB)中的可行性及价值。方法:根据来自MTB的重复插入序列IS6110设计引物,用PCR技术检测CD与ITB肠道组织蜡块标本中MTB DNA,利用基因直接测序法验证结果,分析PCR检测结果与病理特征间的关系。结果:ITB组MTB DNA检出率为32%,CD组MTB DNA检出率为0%,MTB DNA PCR法在ITB和CD鉴别诊断中的灵敏度为32%,显著高于抗酸染色(8%)和干酪样坏死(12%)(P<0.05)。MTB DNA PCR法在ITB和CD鉴别诊断中的特异度为100%,阳性预测值为100%,阴性预测值为59.5%。MTB DNA PCR阳性率在肉芽肿或多核巨细胞病理特征的标本中存在升高趋势,但差异无统计学意义。测序结果与PCR判读的结果相符。结论:PCR法用于MTBDNA检测,有助于ITB确诊,在ITB和CD的鉴别诊断中不失为一种方便快捷的病原学诊断方法。AIM： To identify the feasibility of using polymerase chain reaction （PCR） for detection of Myco- bacterium tuberculosis （MTB） DNA in biopsy tissues and surgical specimens in the form of paraffin blocks from the patients with Crohn disease （CD） or intestinal tuberculosis （ITB）. METHODS ： DNA was amplified by PCR using the primers se- lected from IS6110 in MTB chromosome in ITB and CD specimens. The PCR products were confirmed by polyacrylamide gel electrophoresis and PCR-direct sequencing. The relationship between PCR results and pathological features was also an- alyzed. RESULTS： MTB DNA was positive in 32% and 0% cases of the pathologically or clinically confirmed 25 ITB and 25 CD patients, respectively. The sensitivity of MTB DNA PCR for differential diagnosis of ITB and CD was 32%, signifi- cantly higher than that of acid fast staining （8%） and caseation necrosis （12%）. Specificity, positive and negative pre- dictive values were 100%, 100% and 59.5%, respectively. The positive rate of MTB DNA PCR was higher in the speci- mens with granulation or multinucleated giant cells in our study, although no statistical difference was observed. The se- quencing results coincided with the PCR results. CONCLUSION： PCR can be used to determine MTB in ITB specimens. It is a rapid and convenient assay for the differential diagnosis of ITB and CD.

关 键 词：肠结核 克罗恩病 聚合酶链反应 

分 类 号：R363[医药卫生—病理学]