Tesis

Akurasi Uji Polymerase Chain Reaction (PCR) Urin pada Pasien Terduga Tuberkulosis Paru dengan Kesulitan Sputum = Accuracy of Urine Polymerase Chain Reaction (PCR) Test in Suspected Cases of Sputum-scarce Pulmonary Tuberculosis.

Latar belakang: Xpertâ MTB/RIF merupakan metode diagnosis Tuberkulosis (TB) paru yang beredar luas di Indonesia saat ini, namun pemeriksaan ini sangat bergantung pada ketersediaan sputum. Pada kondisi sputum sulit diperoleh, urin dapat menjadi alternatif spesimen klinis dalam mendiagnosis TB paru. Tujuan: Menilai akurasi pemeriksaan urin dengan metode Real Time Polymerase Chain Reaction (RT-PCR) dibandingkan Xpertâ MTB/RIF dalam mendiagnosis TB paru pada pasien dengan kesulitan sputum. Metode: Sebanyak 75 pasien terduga TB paru dilakukan pemeriksaan Xpertâ MTB/RIF sputum dan pemeriksaan RT-PCR Urin. Hasil: Hasil analisis sensitivitas, spesifisitas, positive predictive value, dan negative predictive value dari uji RT-PCR urin adalah 74,6%, 60,0%, 83,7%, dan 46,2%. Karena akurasi RT-PCR urin dibandingkan dengan Xpertâ MTB/RIF sputum yang bukan merupakan uji diagnostik baku emas TB paru, estimasi akurasi uji RT-PCR urin membutuhkan koreksi. Nilai sensitivitas dan spesifisitas terkoreksi dari uji RTPCR urin, masing-masing mencapai 75,3% dan 76,8%. Kesimpulan: Akurasi diagnostik RT-PCR urin memiliki performa diagnostik yang baik dalam penegakkan diagnosis TB paru dengan kesulitan sputum.
Kata kunci: diagnosis, GeneXpert, PCR, transrenal DNA, tuberkulosis, urin


Background: Xpertâ MTB/RIF is the most extensively used diagnostic tool in pulmonary Tuberculosis (TB) cases, yet this method highly depends on sputum. When sputum is difficult to obtain, urine might be the alternative clinical specimen to diagnose pulmonary TB. Aim: To assess the accuracy of urine examination by using Real Time-Polymerase Chain Reaction (RT-PCR) compared to Xpertâ MTB/RIF in diagnosing sputumscarce pulmonary TB. Methods: Collectively, 75 suspected pulmonary TB subjects underwent sputum examination using Xpertâ MTB/RIF and urine RT-PCR. Results: Analysis showed sensitivity, specificity, positive predictive value, and negative predictive value ofurine RT-PCR were 74.6%, 60.0%, 83.7%, and 46.2%. Due to the accuracy of urine RT-PCR was compared to Xpert â MTB/RIF, which was not the gold standard diagnostic test for pulmonary TB, the estimated accuracy of urine RT-PCR needed correction. The corrected sensitivity and specificity of RTPCR urine were 75.3% and 76.8%, respectively. Conclusion: The diagnostic accuracy of urine RT-PCR showed a good diagnostic performance in diagnosing sputum-scarce pulmonary TB.
Keywords: diagnosis, GeneXpert, PCR, transrenal DNA, tuberculosis, urine