γ-干扰素释放试验联合胸膜组织活检用于诊断结核性胸膜炎的评估  

Assessment the diagnostic power by interferon-gamma release of the whole blood and pleural biopsy in tuberculous pleurisy

作　　者：欧勤芳[1] 高岩[2] 邵凌云[2] 郑建[1] 刘袁媛[2] 沈蕾[2] 翁心华[2] 张文宏[2] 

机构地区：[1]无锡市第五人民医院肺科,无锡市214005 [2]复旦大学附属华山医院感染科

出　　处：《中华实验和临床感染病杂志（电子版）》2014年第3期82-86,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：无锡市科技局社会发展指导性项目(No.CSZ00N1229)

摘　　要：目的评价全血γ-干扰素释放试验联合胸膜活检对结核性胸腔积液诊断的应用价值。方法应用全血γ-干扰素释放试验QuantiFERON-TB Gold In Tube(QFT-GIT)对79例胸腔积液患者进行检测,其中结核性胸腔积液患者45例,非结核性胸腔积液患者34例,结核合并肿瘤患者1例。同时,对其中27例患者进行胸腔镜下胸膜组织活检。结果结核性胸腔积液组,QFT-GIT的阳性率为91.1%(41/45),非结核性胸腔积液组的阳性率为26.5%(9/34)。QFT-GIT试验诊断结核性胸腔积液的敏感性为91.1%(41/45),特异性为73.5%(25/34),阳性预测值为82.0%,阴性预测值为89.3%;胸膜组织活检诊断结核性胸膜炎的敏感性为96.4%(26/27),特异性为100.0%(12/12)。联合胸膜活检诊断结核性胸膜炎的敏感性为95.5%(42/44),特异性为94.1%(32/34)。结论全血γ-干扰素释放试验QFT-GIT联合胸膜组织活检用于诊断结核性胸腔积液具有较高的敏感性和特异性,在我国具有较高的临床应用价值。Objective To evaluate the diagnostic power of combined whole blood interferon-γrelease assay QuantiFERON-TB Gold In Tube （QFT-GIT） and pleural biopsy in tuberculous pleural effusion in China.Methods The whole blood interferon-γ release assay were measured by QFT-GIT test in 45 pleural tuberculosis patients and 34 non-tuberculous pleurisy controls. Among them, 27 patients received thoracoscopy and pleural biopsy.Results The positive rates of QFT-GIT in patients with tuberculous pleurisy and non-tuberculous pleurisy were 91.1% （41/45） and 26.5% （9/34）, respectively. The sensitivity, speciifcity, positive predictive value and negative predictive value of QFT-GIT were 91.1% （41/45）, 73.5%（25/34）, 82.0% and 89.3%, respectively. The pleural biopsy assay applied to tuberculous pleurisy had 96.3%sensitivity and 100.0% speciifcity. Furthermore, combined QFT-GIT and pleural biopsy detection improved the speciifcity to 95.5% （42/44） with the sensitivity up to 94.1% （32/34）.Conclusion The combination of immunoassay and biopsy has a promising prospect in the clinical practice of tuberculous pleurisy.

关 键 词：结核 胸腔积液 全血γ-干扰素释放试验 胸膜活检 诊断 

分 类 号：R521.7[医药卫生—内科学]