先天性ろ紙上リアルタイムPCR法:CMV感染症に対するスクリーニングは感度悪すぎて、不適

ろ紙上でのリアルタイムPCR法は、”陽性者の割合が低い疾患又は感染においても容易に低コストで実施可能な簡便、迅速、高感度なスクリーニング方法”らしい(参照


しかしながら、PCR法は、感度が低く、約2/3の先天性CMV感染を見逃すことがわかった


Dried Blood Spot Real-time Polymerase Chain Reaction Assays to Screen Newborns for Congenital Cytomegalovirus Infection
the National Institute on Deafness and Other Communication Disorders CMV and Hearing Multicenter Screening (CHIMES) Study
JAMA. 2010;303(14):1375-1382.

・single-primer DBS PCR identified congenital CMV infection
sensitivity  28.3% (95% CI, 17.4%-41.4%)
specificit 99.9% (95% CI, 99.9%-100%)
positive LR  803.7 (95% CI, 278.7-2317.9)
negative LR  0.7 (95% CI, 0.6-0.8)
positive predictive value 80.9% (95% CI, 58.1%-94.5%)
negative predictive value 99.6% (95% CI, 99.5%-99.7%)

・The 2-primer DBS PCR assay identified infants with congenital CMV infection with sensitivity 34.4% (95% CI, 18.6%-53.2%)
specificity 99.9% (95% CI, 99.9%-100.0%)
positive LR  3088.9 (95% CI, 410.8-23 226.7)
negative LR 0.7 (95% CI, 0.5-0.8)
positive predictive value 91.7% (95% CI, 61.5%-99.8%)
negative predictive value 99.8% (95% CI, 99.6%-99.9%)

by internalmedicine | 2010-04-14 08:38 | 感染症  

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