Usefulness of Carbohydrate Antigen 19-9 Test in Healthy People and Necessity of Medical Follow-up in Individuals with Elevated Carbohydrate Antigen 19-9 Level / 가정의학회지

BACKGROUND: Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker whose level is elevated in many types of cancers and other benign conditions. CA 19-9 levels are frequently found to be elevated in individuals during general health examinations. This study aimed to investigate the clinical characteristics of such individuals and to determine the need for medical follow-up. METHODS: We investigated individuals who underwent a health inspection, including a serum CA 19-9 test, at our center. Their CA 19-9 levels, age, sex, body mass index (BMI), and personal and past histories were investigated. Additionally, subgroup analyses were performed for those who underwent follow-up study for the elevated CA 19-9 levels. RESULTS: Of 58,498 subjects, 581 (1.0%) had elevated CA 19-9 levels. Multivariate analyses revealed that older age, female sex, lower BMI, and diabetes were independent predisposing factors for elevated CA 19-9 level. A subgroup analysis revealed that the causative conditions were identified in 129 of 351 subjects (36.8%). Among them, the causative conditions in 31 subjects (8.8%, including four cases of cancer and 15 of benign tumors) were not detected at the initial check-up and were found during the follow-up period. CONCLUSION: The use of CA 19-9 as a marker for cancer in healthy individuals is inappropriate. However, medical follow-up in individuals with elevated CA 19-9 levels may be useful because some causative diseases may be detected during follow-up.

Utilidad de la técnica genotypemtbdrplus para el diagnóstico de tuberculosis pulmonar / Utility of the genotype mtbdrplus technique for pulmonary tuberculosis diagnosis

Introducción: es necesario identificar de forma simple y rápida el bacilo Mycobacterium tuberculosis (MTB) para la instauración temprana de tratamiento efectivo y de medidas decontrol que prevengan la transmisión de la enfermedad.Objetivos: evaluar la utilidad de la prueba Genotype MTBDRplus para la identificación de M. tuberculosisen muestras respiratorias de pacientes atendidos en el Hospital Universitario San Vicentede Paúl Fundación entre junio y agosto de 2010.Materiales y métodos: las muestras respiratorias fueron colectadas de 100 pacientes atendidosen el Hospital, a las cuales se les realizó baciloscopia, cultivo en medio Ogawa Kudoh y PCR por la prueba comercial Genotype MTBDRplus. La sensibilidady especificidad de la PCR fue determinada tomandocomo referencia el cultivo en Ogawa Kudoh.Resultados: la sensibilidad, especificidad, valor predictivopositivo y valor predictivo negativo fueron 86,7 %, 93,7 %, 72,2 % y 97,4 % respectivamente. La sensibilidaden muestras con baciloscopia positiva fue 100 % y de 60 % en muestras con baciloscopia negativa. La medianadel tiempo para el reporte por PCR fue 14 días, comparadocon los 60 días requeridos por el cultivo (p=0,000).Conclusiones: La prueba de PCR Genotype MTBDRpluses una buena opción para la detección rápida de M. tuberculosisen muestras respiratorias con baciloscopia positiva.

Introduction: For the early establishment ofeffective treatment and control measures to prevent disease transmission it´s necessary tohave simple and fast diagnostic tools to identify M. tuberculosis (MTB) bacilli.Objetives: In this study, the usefulness of the Genotype MTBDRplus assay for identifying M. tuberculosisin respiratory specimens from patientsat Hospital Universitario San Vicente de Paúl (HUSVP) was evaluated.Materials and methods: Respiratory specimens were collected from 100 patients treated atthe HUSVP to which smear, culture in Ogawa Kudoh medium and commercial Polymerase ChainReaction (PCR) Genotype MTBDRplus assay were performed. The sensitivity and specificity of PCRwere determined in reference to the culture in Ogawa Kudoh.Results: The sensitivity, specificity, positive predictivevalue and negative predictive value were 86.7 %, 93.7 %, 72.2 % and 97.4 % respectively. Sensitivity in smear-positive samples was 100 %,and 60 % in smear-negative samples. The median time for results reporting using PCR was 14 days compared with the 60 days required by the culture (p=0.000).Conclusions: Genotype MTBDRplus is a good choice for rapid detection of M. tuberculosis in smear positive respiratory specimens.