Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Usefulness of PCR Test for M. tuberculosis for the Differentiation of Pulmonary Tuberculosis and Nontuberculous Mycobacterial Lung Disease in Patients with Smear-Positive Sputum

객담 도말 양성 환자에서 폐결핵과 비결핵 항산균 폐질환의 구별을 위한 결핵균 PCR 검사의 유용성

  • Yu, Chang-Min (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Koh, Won-Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ryu, Yon Ju (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeon, Kyeongman (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Jae Chol (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, Eun Hae (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Suh, Gee Young (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chung, Man Pyo (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hojoong (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwon, O Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jang Ho (Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ki, Chang-Seok (Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Nam Yong (Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 유창민 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 고원중 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 류연주 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 전경만 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 최재철 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 강은해 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 서지영 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 정만표 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 김호중 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 권오정 (성균관대학교 의과대학 내과학교실, 삼성서울병원 호흡기내과) ;
  • 이장호 (성균관대학교 의과대학, 삼성서울병원 진단검사의학과) ;
  • 기창석 (성균관대학교 의과대학, 삼성서울병원 진단검사의학과) ;
  • 이남용 (성균관대학교 의과대학, 삼성서울병원 진단검사의학과)
  • Received : 2004.08.31
  • Accepted : 2004.12.07
  • Published : 2004.12.30
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Abstract

Background : Microscopic examination of sputum smears for acid-fast bacilli (AFB) is the most important and rapid diagnostic test for pulmonary tuberculosis. However, the AFB observed on the smear may represent either M. tuberculosis or nontuberculous mycobacteria (NTM). This study examined the clinical usefulness of a polymerase chain reaction test for M. tuberculosis (TB-PCR) for the differentiation of pulmonary tuberculosis and NTM lung disease in patients with smear-positive sputums in a tertiary hospital in Korea. Material and Methods : From January, 2003 to December, 2003, 826 AFB smear-positive and culture-positive sputum specimens were collected from 299 patients. Results : NTM were recovered from 26.6% (220/826) of the smear-positive sputum specimens and 23.4% (70/299) of the patients with smear-positive sputum. All the patients with isolated NTM had clinically significant NTM lung disease; 38 patients (54.3%) had M. avium and 26 patients (37.1%). had M. abscessus. In the patients with pulmonary tuberculosis, 78.7% of the patients (74/94) showed TB-PCR positivity, and all the patients with NTM lung disease showed negative results on the TB-PCR test (p<0.001). A positive result of the TB-PCR test on the sputum or bronchial washing fluid specimens was able to predict pulmonary tuberculosis with 88.4% sensitivity, 100% specificity, a 100% positive predictive value and a 79.7% negative predictive value for the patients with smear-positive sputum. Conclusion : The TB-PCR test for sputum specimens or bronchial washing fluid specimens could be useful for differentiating pulmonary tuberculosis and NTM lung disease for the patients with smear-positive sputum in Korea.

배 경 : 객담 항산균 도말 검사는 저렴하고 간편한 검사이며, 검사 결과를 빨리 얻을 수 있다는 장점이 있지만, 결핵균과 NTM을 구별하지 못한다는 제한점이 있다. 외국에서는 도말 양성 환자에서 폐결핵과 NTM 폐질환을 구별하기 위하여 TB-PCR 검사가 권장되고 있다. 본 연구는 국내에서도 객담 도말 양성 환자에서 객담 또는 기관지 세척액의 TB-PCR 검사가 폐결핵과 NTM 감염의 감별 진단에 유용한가를 알아보고자 하였다. 대상 및 방법 : 2003년 1월 1일부터 2003년 12월 31일까지 1년간 진단검사의학과 임상미생물검사실로 항산균 도말 및 배양검사가 의뢰된 객담 검체 중 도말과 배양이 모두 양성인 826건의 객담 검체를 연구대상으로 하였고, 이 검체가 분리된 환자 299명의 의무기록과 방사선학적 소견을 후향적으로 조사하였다. 결 과 : 결핵균이 분리된 객담은 606건(73.4%)이었고 NTM이 분리된 객담은 220건(26.6%)이었다. 299명의 환자 중 결핵균이 분리된 폐결핵 환자는 229명(76.6%)이었고, NTM이 분리된 환자는 70명(23.4%)이었으며 모두 임상적 의의가 있는 NTM 폐질환 환자였으며, 원인균은 M. avium complex 38명(54.3%), M. abscessus 26명(37.1%), 기타 6명 등이었다. 폐결핵 환자 229명 중 112명(48.9%)와 NTM 폐질환 환자 70명 중 51명 (72.9%)에서 객담 또는 기관지 세척액을 이용한 TB-PCR 검사가 시행되었다. 검사를 시행한 폐결핵 환자 112명 중 99명(88.4%)에서 TB-PCR 검사가 양성을 보였고, NTM 폐질환 환자는 모두 음성을 보였다 (p<0.001). 객담 도말 양성 환자에서 객담 또는 기관지 세척액의 TB-PCR 검사 양성 반응이 폐결핵을 예측하는 민감도와 특이도는 각각 88.4%(99/112)와 100%(51/51)였고, 양성 예측치는 100%(99/99) 그리고 음성 예측치는 79.7%(51/64)였다. 결 론 : 객담 항산균 도말 양성을 보이는 환자에서 객담 또는 기관지 세척액 TB-PCR 검사는 국내에서도 폐결핵과 NTM 폐질환을 구별하는데 임상적 유용성이 있을 것으로 사료된다.

Keywords

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