摘要
目的:探讨γ-干扰素释放试验(IGRA)在肺结核和肺外结核诊断中的应用价值。方法:收集273例结核病患者与45例健康体检者肝素钠抗凝全血,采用国产IGRA试剂检测其血浆γ-干扰素含量,同时与结核菌素皮肤试验(TST)结果进行平行分析比较;采用抗酸染色(AFB染色)法对结核病患者痰液标本进行染色。结果:国产的IGRA试剂和TST实验的敏感性分别为85.35%和72.53%,特异性分别为86.54%和53.33%,阳性预测值分别为97.08%和90.41%,阴性预测值分别为52.94%和24.24%,准确性分别为85.22%和69.81%。两种方法对肺结核的检出率分别为85.71%(180/210)和74.76%(157/210),二者相比较,差异有统计学意义(χ2=7.943,P<0.01);两种方法对肺外结核的检出率分别为84.13%(53/63)和68.25%(43/63),二者相比较,差异也有统计学意义(χ2=4.375,P=0.036);但两种方法各自对肺结核与肺外结核的检测效果无显著差异。210例肺结核患者中AFB阳性73例,AFB阴性者137例,其中AFB阳性肺结核患者中IGRA阳性率为89.04%(65/73),AFB阴性肺结核患者阳性率为83.94%(115/137);肺外结核63例患者AFB均阴性,IGRA阳性率为84.13%(53/63)。结论:IGRA比TST对诊断结核病有较高的敏感性与特异性,尤其是对AFB阴性的肺结核和肺外结核有80%以上的检出率,有很好的临床应用前景。
Objective： To evaluate the clinical application of T-cell based interferon-γ release assays（IGRA） for the diagnosis of pulmonary tuberculosis and extrapulmonary tuberculosis.Methods： A total of 273 cases of tuberculosis and 45 healthy controls were detected with IGRA and tuberculin skin test（TST）.Direct smear of sputum was conducted with Ziehl-Neelsen acid-fast bacilli（AFB） staining to detect tubercle bacillus.Results： The sensitivity,specificity,positive value（PPV）,negative predictive value（NPV） and compliance rates of IGRA and TST were 85.35% and 72.53%,86.54% and 53.33%,97.08% and 90.41%,52.94% and 24.24%,85.22% and 69.81%,respectively.The positive rate of both methods were 85.71%（180/210） and 74.76%（157/210） in pulmonary tuberculosis（χ 2 = 7.943,P 0.01）,while 84.13%（53/63） and 68.25%（43/63） in extrapulmonary tuberculosis（χ 2 = 4.375, P = 0.036）.There were no significant deviations in the detection effectiveness of each in pulmonary tuberculosis and extrapulmonary tuberculosis.Nevertheless,only 73 cases of 210 cases of pulmonary tuberculosis presented positive acid fast stain,and 63 cases of extrapulmonary tuberculosis was negative.The positive rate of IGRA in AFB positive and AFB negative pulmonary tuberculosis were 89.04%（65/73） and 83.94%（115/137）,while 84.13%（53/63） in extrapulmonary tuberculosis.Conclusion： IGRA, by which the detection rate is more than 80% in AFB negative pulmonary tuberculosis and extrapulmonary tuberculosis,has higher sensitivity than TST,and could be used as a valued index to evaluate tuberculosis infection.
出处
《武汉大学学报（医学版）》
CAS
北大核心
2013年第3期403-406,共4页
Medical Journal of Wuhan University
关键词
Γ-干扰素释放试验
肺结核
肺外结核
诊断
IFN-γ Release Assays
Pulmonary Tuberculosis
Extrapulmonary Tuberculosis
Diagnosis
