IGRA检测在结核性胸膜炎中的诊断价值  

Diagnostic value of interferon gamma release assay(IGRA) in patients with tuberculous pleurisy

作　　者：李津[1] 潘燕玉[1] 张宝华[2] 程小星[3] 

机构地区：[1]南京军区福州总医院结核科,福建福州350003 [2]南京军区福州总医院二部检验科,福建福州350003 [3]中国人民解放军总参谋部总医院结核病研究所,北京100091

出　　处：《临床肺科杂志》2014年第6期1055-1057,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的评价γ干扰素释放试验在结核性胸膜炎患者中的诊断价值。方法选取入住本院的116例可疑结核性胸膜炎(tuberculous pleurisy,TBP)患者,同时采集全血和胸水进行T-SPOT.TB检测,利用结核分枝杆菌特异性抗原ESAT-6和CFP-10与全血和胸水细胞共同培养,按说明判读检测结果。结果 116例可疑结核性胸膜炎患者中有91例被确诊为活动性结核感染,25例排除结核感染。全血细胞诊断TBP的敏感性是79.1%,特异性是64.0%。胸水细胞诊断TBP的敏感性是90.1%,特异性是88.0%。两组患者比较TSPOT.TB阳性率有显著差异(P<0.001)。联合全血和胸水细胞T-SPOT.TB结果阳性预测值等于100%(72/72),阴性预测值等于94.1%(16/17)。结论采集胸水细胞进行T-SPOT.TB检测对诊断TBP具有可行性,联合全血和胸水进行T-SPOT.TB检测对于TBP的诊断意义会更大。Objective To evaluate the diagnostic value of IGRA in patients with tuberculous pleural. Meth-ods 116 patients with suspected tuberculosis pleurisy were selected in this study, and their whole blood and pleural effusion were given T-SPOT. TB detection. PBMCs isolated from whole blood and pleural effusion were co-cultured with mycobacterium tuberculosis-specific antigens ESAT-6 and CFP-10, then the spots were counted which formed by specific T cells. Results 91 patients were diagnosed with active TB infection, and the other 25 patients were diag-nosed with non-TB infection. For diagnosing TBP, the sensitivity and specificity of PBMCs from whole blood were 79. 1% and 64. 0% respectively. The relative proportions with cells from pleural effusion were 90. 1% and 88. 0% re-spectively. The positive rate of T-SPOT. TB was significantly higher in the ATB group than in the non-TB group （ P〈0. 001）. The results of T-SPOT. TB combined whole blood PBMCs with pleural effusion cells had a positive predictive value of 100% （72/72） and a negative predictive value of 94. 1% （16/17）. Conclusion T-SPOT. TB assay with pleural effusion cells can be used in the diagnosis of TBP, and the diagnostic value will be even greater while combi-ning with the IGRA results from whole blood and pleural fluid cells.

关 键 词：结核性胸膜炎 全血 胸水 IGRA T—SPOT TB 

分 类 号：R521.7[医药卫生—内科学]