폐결핵 진단을 위한 실시간중합효소연쇄반응과 AFB 염색진단검사의정량적 연관성 비교
Comparison of Quantitative Relationship between Real-Time PCR and Acid Fast Bacilli Staining for Diagnosis of Pulmonary Tuberculosis
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초록
본 연구는 Cobas TaqMan MTB 검사(CTM test, Roche Diagnostics, Basel, Switzerland)와 항산균 도말염색검사의연관성을 확인하고 그에 따른 반정량적 판정기준을 확립하고자하였다. 2015년 1월부터 2015년 12월까지 삼성서울병원 진단검사의학과에 의뢰된 8,389개의 검체에 대해 결핵균 도말 검사, 배양 검사 및 CTM 검사를 동시에 실시하였으며, 그 결과를 분석하여 AFB 염색과주기의 연관성을 후향적으로 분석하였다. CTM 검사의 임계 값(Ct)값으로, 결핵균 검출방법의 반정량적판정기준을 설정 하였다. CTM 검사의 135개의 양성 표본에 대한 Ct값은 항산균 도말염색과 반비례적 상관관계가 있었다(rs= −0.545, P＜0.01). CTM 검사와 항산균 염색 등급의 음의 상관관계가 입증되었으며, 임상 기준에 이러한 기준을 적용하여 임상적 의의를 검증하였다. 이 연구의 반정량적 기준은 병원에서활동성 결핵 및 감염을 일으킬 수 있는 환자의 빠른 진단의 판단에 도움이 될 것으로 사료된다.
Abstract
This study investigates the association of the AFB stain with the cycle threshold (Ct) value of the Cobas TaqMan MTB test (CTM test, Roche Diagnostics, Basel, Switzerland), and it establishes the base data for semi-quantitative identification of M. tuberculosis by the Ct value. CTM test were simultaneously conducted on 8,389 specimens submitted to the Samsung Medical Center from January 2015 to December 2015, and the results were analyzed and compared retrospectively investigates the association of the AFB stain with the Ct value of the CTM test, and it establishes the base data for semi-quantitative identification of M. tuberculosis by the Ct value. The Ct values for 135 positive specimens of the CTM were inversely correlated with the AFB stain (rs=−0.545, P＜0.01). When the Ct value of the CTM test and the time to positivity (TTP) of the mycobacteria cultures were verified based on the AFB stain, they were found to have a positive correlation (rs=0.136, P＜0.01). The negative correlation between the CTM test and the AFB stain grade was demonstrated. The clinical significance was verified by applying these criteria to the clinical results. The semiquantitative criteria of this study can be used to facilitate the rapid isolation of patients with active tuberculosis and infection control in the hospital.
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