γ干扰素释放试验在儿童肺结核诊断中的价值  

Performance of interferon γ release assays in diagnosis of childhood pulmonary tuberculosis

作　　者：鲍磊[1] 李涛[1,2] 卢水华[2] 张文宏[1] 

机构地区：[1]复旦大学附属华山医院感染科,上海200040 [2]上海市公共卫生临床中心,上海201508

出　　处：《微生物与感染》2014年第2期96-101,共6页Journal of Microbes and Infections

基　　金：上海市卫生局青年基金(20114Y086)

摘　　要：为研究2种γ干扰素释放试验(IGRA)试剂盒在结核病高发、卡介苗(BCG)高接种地区用于诊断儿童肺结核的价值,共入组临床怀疑肺结核患儿114例,其中45例行QuantiFERON-Gold In-Tube(QFT-GIT)检测,69例行T-SPOT.TB检测,收集临床资料,比较2种方法的灵敏度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。结果显示,QFT-GIT在儿童肺结核诊断中的灵敏度为84.6%、特异度为81.3%、PPV为91.7%、NPV为76.5%。T-SPOT.TB的灵敏度为72.3%、特异度为93.7%、PPV为97.1%、NPV为53.6%。与未治疗患儿相比,激素治疗患儿QFT-GIT和T-SPOT.TB的阳性率显著下降。研究提示,QFT-GIT和TSPOT.TB较少受潜伏性结核感染的影响,用于中国儿童肺结核的诊断具有较高的PPV。In order to investigate the performance of two kinds of interferon γrelease assays in the diagnosis of childhood pulmonary tuberculosis in China （with a high rate of bacillus Calmette-Gu＆#233;rin vaccination and a high incidence of tuberculosis ） , a total of 114 children with suspected pulmonary tuberculosis were recruited .Among the cases ,45 received QuantiFERON-Gold In-Tube （QFT-GIT ） test while the other 69 were tested with T-SPOT .TB . The clinical information was collected for diagnostic classification . The sensitivity ,specificity ,positive predictive value （PPV） and negative predictive value （NPV） were compared between the two methods .The sensitivity of QFT-GIT in the diagnosis of childhood pulmonary tuberculosis was 86 .4% ,the specificity was 81 .3% ,PPV was 91 .7% ,and NPV was 76 .5% .In contrast ,the sensitivity of T-SPOT .TB was 72 .3% , the specificity was 93 .7% , PPV was 97 .1% , and NPV was 53 .6% . The positive rates of two methods in the cases treated with glucocorticoids decreased significantly compared to those untreated .In conclusion ,both QFT-GIT and T-SPOT .TB have high PPV in the diagnosis of childhood pulmonary tuberculosis since the rate of latent tuberculosis infection was low in children .

关 键 词：儿童 肺结核 Γ干扰素释放试验 

分 类 号：R521[医药卫生—内科学]