γ-干扰素释放试验对儿童结核性脑膜炎的诊断价值  

The value of interferon gamma release assays in the diagnosis of tuberculous meningitis in children

作　　者：母发光[1] 何海兰[1] 谭泰昌[2] 李毅[3] 

机构地区：[1]四川省医学科学院四川省人民医院儿科,四川成都610072 [2]四川省医学科学院四川省人民医院免疫室,四川成都610072 [3]四川省阿坝州人民医院儿科,四川马尔康624000

出　　处：《临床儿科杂志》2015年第3期242-246,共5页Journal of Clinical Pediatrics

摘　　要：目的探讨γ-干扰素释放试验(IGRAs)对儿童结核性脑膜炎的诊断价值。方法采用前瞻性病例对照研究方法,比较2012年6月至2013年12月住院的32例结核性脑膜炎患儿(TBM组)和30例非结核性颅内感染患儿(非TBM组)的IGRAs、结核菌素皮肤试验(TST)、结核杆菌抗体(TB-Ig G)及脑脊液结核分枝杆菌DNA(TB-DNA)阳性率的差异,以及各指标的灵敏度、特异度、阳性预测值和阴性预测值。结果 IGRAs、TST、TB-Ig G、脑脊液TB-DNA,在TBM组的阳性率分别为87.50%、56.25%、46.88%、34.38%,非TBM组为6.67%、23.33%、20%、0%,差异均有统计学意义(P<0.05)。IGRAs、TST、TB-Ig G、TB-DNA的灵敏度分别为87.5%、56.25%、46.88%、34.38%,特异度分别为93.33%、76.67%、80.00%、100%,各指标灵敏度和特异度的差异均有统计学意义(P<0.05);IGRAs的灵敏度高于其他三项指标,差异均具有统计学意义(P<0.017)。IGRAs、TST、TB-Ig G、TB-DNA的阳性预测值分别93.33%、72%、71.43%、100%,阴性预测值分别为87.50%、62.16%、58.54%、58.82%。结论 IGRAs、TST、TB-Ig G、TB-DNA对结核性脑膜炎都具有诊断价值,IGRAs的灵敏度和特异度相对较高。Objective To investigate the diagnostic value of interferon gamma release assays（IGRAs） in children with tuberculous meningitis.Methods The prospective case-control study was applied.From January 2012 to March 2013,32 children diagnosed with tuberculous meningitis（TBM group） and 30 children diagnosed with non-tuberculous meningitis（non-TBM group） were recruited.The positive rates of the interferon gamma release assays（IGRAs）,tuberculin skin test（TST）,mycobacterium tuberculosis antibody test（TB-IgG）,cerebrospinal fluid of mycobacterium tuberculosis DNA test（TB-DNA）,and the sensitivity,specificity,negative and positive predictive value of all these tests were compared between TBM group and non-TBM group.Results The positive rate of IGRAs,TST,TB-IgG,and TB-DNA was 87.50%,56.25%,46.88% and 34.38% respectively in TBM group,and 6.67%,23.33%,20% and 0% respectively in non-TBM group.The differences were statistically significant（P〈0.05）.The sensitivity of IGRAs,TST,TB-IgG,and TB-DNA was 87.5%,56.25%,6.88% and 34.38% respectively.The specificity of IGRAs,TST,TB-IgG,and TB-DNA was 93.33%,76.67%,80.00% and 100% respectively.The differences of sensitivity and specificity were statistically significant（P〈0.05）.The sensitivity of IGRAs was higher than that of other tests（P〈0.017）.The positive predictive value of IGRAs,TST,TB-IgG,and TB-DNA was 93.33%,72%,71.43% and 100% respectively.The negative predictive value was 87.50%,62.16%,58.54% and 58.82% respectively.Conclusions IGRAs,TST,TB-IgG,and TB-DNA are valuable in the diagnosis of tuberculous meningitis.IGRAs has a relatively higher sensitivity and specificity.

关 键 词：结核性脑膜炎 Γ-干扰素释放试验 诊断 儿童 

分 类 号：R529.3[医药卫生—内科学]