摘要
目的:探究γ-干扰素释放试验(interferon-γrelease assays,IGRAs)联合可产生γ-干扰素(interferon-γ,INF-γ)的斑点形成细胞(spot-forming cells,SFC)数量、酶联免疫斑点检测法(enzyme-linked immunospot assay,ELISPOT)模型识别活动性结核与潜伏性结核的诊断效能。方法:选取2017年9月-2018年12月在笔者所在医院就诊的结核分枝杆菌感染患者312例,其中活动性肺结核组154例记为活动组,潜伏性结核分枝杆菌感染158例记为潜伏组。通过受试者工作特征曲线(ROC曲线)分析γ-干扰素释放试验、SFC及ELISPOT联合诊断模型识别活动性及潜伏性结核的诊断价值。结果:活动组γ-干扰素释放试验结果高于潜伏组,SFC高于潜伏组,ELISPOT阳性率(78.6%)高于潜伏组(31.0%),差异均有统计学意义(P<0.05)。γ-干扰素释放试验诊断的临界值为2.72 IU/ml,其对应灵敏度为79.1%,特异度为52.5%,ROC曲线下面积为0.768[95%CI(0.708,0.829)];SFC诊断临界值为2.78,其对应的灵敏度为75.3%,特异度为60.8%,ROC曲线下面积为0.768[95%CI(0.711,0.825)];ELISPOT阳性诊断临界值为4.27 mg/L,其对应灵敏度为70.8%,特异度为51.3%,ROC曲线下面积为0.620[95%CI(0.546,0.694)]。行Logistic回归分析,得到联合诊断模型Logit(P)=1.433+2.512γ-干扰素释放试验+1.654 SFC+1.121 ELISPOT,联合检测截断值为2.47,对应灵敏度为74.7%,特异度为80.4%,ROC曲线下面积为0.851[95%CI(0.806,0.896)]。联合检测特异度及曲线下面积均高于各指标单独检测,差异均有统计学意义(P<0.05),且联合检测保持较好的灵敏度。结论:γ-干扰素释放试验、SFC及ELISPOT联合诊断模型可提高活动性结核的特异度,并保持较高的灵敏度,在鉴别活动性及潜伏性结核感染方面具有重要的临床价值。
Objective:To explore the diagnostic value of Spot-forming cells(SFC)and enzyme linked immunospot assay(ELISPOT)in combination with interferon-γrelease assays(IGRAs)in active and latent tuberculosis.Method:A total of 312 patients with mycobacterium tuberculosis infection who visited our hospital from September 2017 to December 2018 were selected.Among them,154 patients in the active tuberculosis group and 158 patients with latent mycobacterium tuberculosis infection were recorded as the latent group.The diagnostic value of IFN-γrelease test,SFC and ELISPOT combined diagnostic model in active and latent tuberculosis was analyzed by ROC curve.Result:The result of IFN-γrelease test in the active group was higher than that in the latent group,the level of SFC in the active group was higher than that in the latent group,the positive rate of ELISPOT in the active group(78.6%)was higher than that in the latent group(31.0%),the differences were statistically significant(P<0.05).The diagnostic threshold of IFN-γrelease test was 2.72 IU/ml,the corresponding sensitivity was 79.1%,the specificity was 52.5%,and the area under ROC curve was 0.768[95%CI(0.708,0.829)].The diagnostic threshold of SFC diagnosis was 2.78,the corresponding sensitivity was 75.3%,the specificity was 60.8%,and the area under ROC curve was 0.768[95%CI(0.711,0.825)].The diagnostic threshold of positive diagnosis of ELISPOT was 4.27 mg/L,the corresponding sensitivity was 70.8%,the specificity was 51.3%,and the area under ROC curve was 0.620[95%CI(0.546,0.694)].The combined diagnosis model Logit(P)=1.433+2.512γ-interferon release test+1.654 SFC+1.121 was obtained by logistic regression analysis,and the diagnostic threshold of combined diagnosis model was 2.47,and the sensitivity of it was 74.7%,the specificity was 80.4%,and the area under ROC curve was 0.851[95%CI(0.806,0.896)].The specificity and the area under the curve of combined detection were higher than those of individual detection,the differences were statistically significant(P<0.05),and the combined detection maintained good sensitivity.Conclusion:IFN-γrelease test,SFC and ELISPOT combined diagnosis model can improve the specificity of active tuberculosis,and maintain high sensitivity,which has important clinical value in distinguishing active and latent tuberculosis infection.
作者
李玉美
陈胤文
余晓琳
洪建明
林炳耀
曾今诚
林东子
LI Yumei;CHEN Yinwen;YU Xiaolin;HONG Jianming;LIN Bingyao;ZENG Jincheng;LIN Dongzi(The Sixth People’s Hospital,Dongguan 523008,China;不详)
出处
《中外医学研究》
2020年第21期14-17,共4页
CHINESE AND FOREIGN MEDICAL RESEARCH
