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RISS 인기검색어
- 검색키워드
- 주제어 : Intestinal tuberculosis, Crohn's disease, Histopathologic features, TB-PCR, commercial kit, IS6110, MPB64 (검색결과 4 건)
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장결핵 감별진단에 있어서 혈중 감마인터페론 검사의 유용성
Background: The differential diagnosis of intestinal tuberculosis (TB) from other chronic intestinal inflammatory conditions such as Crohn's disease and intestinal Behcet disease is very difficult because they have similar clinical and endoscopic features. Recently, a new diagnostic method that can detect interferon-gamma produced by M. tuberculosis-specific antigens has been developed a whole-blood interferon-gamma assay (QuantiFERON??-TB Gold test) has no booster effect, less inter-observer variation, and lower false positive reaction produced by BCG vaccination or non-tuberculous Mycobacterium infection. It has been approved as a mean to diagnose latent TB by the Food and Drug Administration. However, its usefulness in the diagnosis of intestinal TB has not been known well so far. The aim of this study was to find out the usefulness of a whole blood interferon-gamma assay in the differential diagnosis of intestinal TB. Methods: QuantiFERON??-TB Gold test was performed in 44 patients who had terminal ileal and/or colonic ulcerative lesions on colonoscopy. The author analyzed its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the diagnosis of intestinal TB. These results of QuantiFERON??-TB Gold test were compared to those of the conventional diagnosing means, the presence of caseating granuloma and/or AFB on the histologic examination. Results: Among 44 patients, 12 (27.3%) were finally diagnosed as intestinal TB. Eleven patients (25%) showed the positive reaction for QuantiFERON??-TB Gold test. Three patients (6.8%) showed the granuloma with caseation necrosis, and only two (4.5%) presented acid fast bacilli (AFB) on Ziehl-Neelsen staining. The QuantiFERON??-TB Gold test had high sensitivity, specificity, PPV, and NPV for the diagnosis of intestinal TB; 91.7%, 100%, 100%, and 97% respectively. Meanwhile, the presence of caseating granuloma had high specificity (100%) and PPV (100%), but low sensitivity (25%) and NPV (78%). the presence of AFB also had high specificity (100%) and PPV (100%), but very low sensitivity (28.6%) and NPV (28.6%). Conclusion: A whole blood interferon-gamma assay is very useful for the differential diagnosis of intestinal TB from the other chronic inflammatory bowel diseases. Further large scaled study should be warranted. 배경: 장결핵은 임상소견 및 내시경 소견이 크론병이나 베체트 장염과같은 염증성 장질환과 유사하여 감별진단이 매우 어렵다. 혈중 감마인터페론 검사(QuantiFERON??-TB Gold test)는 최근 미국 식품의약청에서 잠복결핵의 진단을 위한 방법으로 승인된 검사로 booster 효과가 없고 판독자에 의한 오차가 적으며 BCG 접종이나 비결핵 항산균 감염으로 인한 위양성이 적어 특이도가 높다는 등의 장점을 가지고 있다. 이를 근거로 최근 폐결핵에 관한 연구들은 많이 진행되어 왔으나 아직 국내외적으로 장결핵에서 혈중 감마인터페론 검사에 대한 연구는 미비한 실정이다. 이 연구에서 저자는 장결핵의 감별진단에 있어서 혈중 감마인터페론 검사의 유용성을 알아보고자 하였다. 방법: 2004년부터 경상대학교 병원에서 대장내시경검사를 받고 종말 회장이나 대장의 궤양 병변을 보였던 환자를 대상으로 혈중 감마인터페론 검사를 시행하여 장결핵의 진단에 있어서 혈중 감마인터페론 검사의 민감도, 특이도, 양성 예측치, 음성 예측치를 분석하였다. 결과: 연구 대상자는 총 44명으로 평균연령은 44.8 ± 18.8세(17-80세), 남성과 여성은 각각 19명과 25명이었다. 그 중 장결핵으로 최종진단을 받은 환자는 12명(27.3%)이었고 혈중 감마인터페론 검사는 11명(25%)에서 양성이었고, 조직검사에서 건락육아종은 3명(6.8%), 항산균 염색 검사에서 양성소견은 2명(4.5%)에서 관찰할 수 있었다. 혈중 감마인터페론 검사의 민감도 91.7%, 특이도 100%, 양성 예측치 100%, 음성 예측치 97%이었다. 건락육아종의 존재는 민감도 25%, 특이도 100%, 양성 예측치 100%, 음성 예측치 78%이었고, 항산균 염색 검사는 민감도 28.6%, 특이도 100%, 양성 예측치 100%, 음성 예측치 28.6%이었다. 결론: 혈중 감마인터페론 검사는 궤양성 병변을 보이는 만성 염증성 장질환으로부터 장결핵의 감별진단에 매우 유용한 검사이다. 향후 많은 수의 환자를 대상으로 하는 연구가 필요할 것으로 생각한다.
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진샨지 인하대학교 대학원 일반대학원 2008 국내석사
Background and objectives: Differential diagnosis of intestinal tuberculosis(ITB) and Crohn's disease(CD) is difficult, because of clinical and pathologic similarities. Even though many pathologic and molecular studies have been performed, it is still difficult to differentiate. PCR for M. tubeculosis (TB-PCR) method has been accepted as an ancillary test for differential diagnosis of ITB and CD. Recently, many kinds of commercial kits have been developed using different targets to detect the M. tuberculosis genome, but their diagnostic accuracy was not sufficiently examined. In this study, we compared the histopathologic features of ITB and CD, and evaluate the diagnostic significance of TB-PCR in formalin fixed and paraffin-embedded specimen of endoscopic biopsy. For this purpose, we used two commercially available TB-PCR kits in Korea and compare the results with in-house PCR method which have been reported in many literatures. Methods: We selected 97 patients with established diagnosis, 55 cases of ITB and 42 cases of CD, all of them performed colonoscopic biopsy. Microscopic features of ITB and CD were reviewed and eight pathologic parameters were evaluated. For control of TB-PCR test, 9 AFB culture-positive specimens and 10 normal colonic tissues were evaluated as gold standard. PCR assays were done using two commercial kits <A> detected IS6110 and MPB64 and kit <B> detected IS6110 only and manual in-house PCR method in formalin-fixed, paraffin-embedded colonoscopic biopsy specimens. Results: All evaluated histopathologic criteria such as ulcer with bands of epithelioid histiocytes, size and number of granuloma, giant cell, caseation necrosis, confluent granuloma, discrete granuloma, granuloma with lymphoid cuff were statistically significant for differential diagnosis of ITB and CD. However, 29 cases(52.7%) of ITB showed less than half of these pathologic parameters which resulted in confusion with CD. The sensitivity and specificity of TB-PCR test by kit <A>, kit <B> and in-house PCR method, were 88.9% and 100%, 88.9% and 100%, 66.7% and 100% in gold standard. In endoscopic biopsy specimens of ITB and CD, the sensitivity and specificity of PCR test were 45.5% and 88.1%, 36.4% and 100%, 5.8% and 100%, by kit <A>, kit <B> and in-house PCR method, respectively. Among the 29 cases confused with CD, 10 cases (by kit <A>) and 6 cases (by kit <B>) were TB-PCR positive. A combination of histologic finding and TB-PCR test led to increasing of diagnostic sensitivity from 47.3% to 58.2-65.5%. Conclusion: Commercially available TB-PCR kits showed higher sensitivity and specificity to detect M. tuberculosis than in-house method. TB-PCR test combined with histopathologic factors appears to be a helpful technique in differential diagnosis of ITB and CD in endoscopic biopsy samples.
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