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題名 | Comparison of Multiplex Polymerase Chain Reaction, Culture, and Serology for the Diagnosis of Bordetella Pertussis Infection=多引子聚合酶鏈鎖反應,細菌培養及血清學檢查三種診斷百日咳感染方法的比較 |
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作者 | 賈儒馨; 蘇玲慧; 林本一; 邱政洵; 郭安靜; 孫建峰; 吳竹蘭; | 書刊名 | 長庚醫學 |
卷期 | 27:6 2004.06[民93.06] |
頁次 | 頁408-415 |
分類號 | 415.279 |
關鍵詞 | 多引子聚合酶鏈鎖反應; 百日咳鮑特氏菌; 鼻咽拭子; Bordetella pertussis; Multiplex PCR; Nasopharyngeal swab specimens; |
語文 | 英文(English) |
中文摘要 | 背景:正確診斷百日咳鮑特氏菌(Bordetella pertussis)所引起的百日咳感染並不容易。一般使用菌培養,而以聚合?鏈鎖反應(PCR)作為診斷方法,則具有較高敏感性,但相關文獻對於敏感性的報告並不一致。因此,本篇文章以回溯研究的方式,將臨床上用以鑑定百日咳感染的細菌培養、血清學檢查以及一多引子聚合?鏈鎖反應(Multiplex PCR)三種診斷方法加以比較。 方法:將193位病患取得的成對鼻咽拭子,同時進行細菌培養及多引子聚合?鏈鎖反應,其中的103位病患有血清學檢查的結果。當培養結果。當培養結果與血清學檢查或是多引子聚合?鏈鎖反應的結果不一致時,則進一步分析病患的臨床資料,看是否符合美國疾病管制中心(CDC)對於百日咳臨床病例的認定標準。 結果:在193對鼻咽試子中,有25個檢體為多引子聚合?鏈鎖反應陽性,而其中的11個可培養出百日咳鮑特氏菌。在103個有血清學檢查結果的檢體,有3個檢體的三種診斷方法皆為易性,另有69個則皆為陰性。以細菌培養為標準,則多引子聚合?鏈鎖反應及血清學檢查的靈敏度分別為100%與50%,專一性分吸為92%與80%。當標準延展為(1)細菌培養陽性或是(2)多引子聚合?鏈鎖反應或是血清學檢查陽性,而其臨床狀符合美國疾病管制中心對於百日咳臨床病例的認定標準,且已接受抗生素治療10天以上,在14個單獨多引子聚合?鏈鎖及應陽性及19個單獨血清學檢查陽性的病患中,分別有11個及6個患者被認定為百日咳病例。則多引子聚合?鏈鎖反應的靈敏度與專一性分吸為79%及98%,血清學檢查為47%及85%,而細菌培養的專一性為100%,但靈敏度附為39%。 結論:本實驗證實了此多引子聚合?鏈鎖反應的高靈敏度與專一性,可提供臨床上快速且正確地診斷百日咳感染。 |
英文摘要 | Backgorund: Accurate diagnosis of Bordetella pertussis infection is difficult. Polymerase chain reaction (PCR) tests are more sensitive than culture, but the reported sensitivity is variable. We prospectively compared the performance of culture, serology, and a multiplex PCR for the detection of B. pertussis. Methods: A total of 193 paired nasopharyngeal (NP) swab specimens were examined by both culture and a multiplex PCR. Serology results were available in 103 patients. Medical charts of the patients with discrepant laboratory findings were reviewed and compared with the United States Centers for Disease Control and Prevention (CDC) clinical case definition. Results: Of the 193 specimens, 11 were positive on both culture and PCR, and 14 were positive on PCR only. Of the 103 specimens with serology-positive Eleven of the 14 PCR-positive only cases and 6 of the 19 serology-positive only cases were defined as true pertussis cases according to an expanded standard which includes either (1) culture positive or (2) PCR or serology positive with clinical features fulfilling the CDC clinical case definition and the patients having received macrolides treatment for more than 10 days. The sensitivity and specificity of the multiplex PCR were 79% and 98%, respectively, while those for serology were 47% and 85Q%, and for culture 39% and 100%. Conclusions: Our data confirm the superior sensitivity of the multiplex PCR in detection of B. pertussis, compared with conventional culture and serology. Clinical validation indicates that the multiplex PCR offers specific detection of B. pertussis from NP specimens. |
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