γ干扰素释放试验在不同年龄活动性结核病患儿诊断中的应用价值  

Performance of the interferon gamma release assay for diagnosis of tuberculosis in children in different ages

作　　者：孙琳[1] 田建岭[1] 尹青琴[1] 李洁琼[1] 郭雅洁[1] 綦辉[1] 肖婧[1] 徐放[1] 焦伟伟[1] 申晨[1] 申阿东[1] 

机构地区：[1]首都医科大学附属北京儿童医院北京市儿科研究所结核病研究室教育部儿科重大疾病研究重点实验室儿童呼吸系统感染性疾病研究北京市重点实验室,100045

出　　处：《中国防痨杂志》2015年第7期757-763,共7页Chinese Journal of Antituberculosis

摘　　要：目的评价γ干扰素释放试验（interferongammareleaseassays，IGRAs）在不同年龄活动性结核病患儿诊断中的应用价值。方法搜集2011年3月至2013年6月期间，我院临床诊断为活动性结核病的患儿205例、非结核呼吸系统感染患儿867例进行回顾性分析。根据年龄分为不同亚组（0～岁组136例，2～岁组323例，6～岁组312例，10～18岁组301例），分析IGRAs和结核菌素皮肤试验（tuberculinskintest，TST）在各亚组中的敏感度、特异度、一致性等。准确度以受试者特征工作曲线下面积（Auc）评价。结果在总的研究对象中，IGRAs的敏感度（85．4％，175／205）与TST试验（81．5％，167／205）接近（χ^2=1．128，P〉0．05）；在0～岁组患儿中，IGRAs的敏感度（80．0％，24／30）高于TST（53．3％，16／30）（χ^2=0．03，P〉0．05），但差异无统计学意义。在各年龄组中IGRAs的特异度均显著高于TST（0-岁，99．1％和86．8％，χ^2=12．125，P〈0．01；2～岁，93．9％和73．6％，χ^2=41．603，P〈0．01；6～岁，92．2X和77．0％，χ^2=23．948，P〈0．01；10～18岁组，88．8％和65．6％，χ^2=33．040，P〈0．01）。0-岁组、2～岁组和10-18岁组中IGRAs检测的AUC（分别为0．895、0．882、0．893）均高于TST（分别为0．701、0．770、0．764）（P值均〈0．05），6～岁组中IGRAs检测和TsT的AUC差异无统计学意义，分别为0．895和0．838，P〉0．05；Kappa值均小于0．40。4个年龄组间，IGRAs检测的AUC差异无统计学意义（P值均〉0．05）。IGRAs试验结果总的不确定率为8．6％（101／1173），10～18岁组的不确定率显著低于其他年龄组（0～岁，2～岁，6～岁，10～18岁分别为10．5％，10．0%，8．0％，6．8％，χ^2=859．9，P〈0．01）。结论IGRAs在各年龄阶段儿童具有较好的敏感度和特异度，在活动性结核病患儿的辅助诊断中均具有一定的应用价值。Objective To analyze the performance of interferon gamma release assays （IGRAs） for diagnosis of tuberculosis in children in different age. Methods The diagnostic accuracy of IGRAs and TST were assessed in 205 children with active tuberculosis and 867 children with nontuberculous respiratory infection, who were referred to the Beijing Children＇s Hospital during the period from March 2011 through June 2013. Sensitivity, specificity and concordance were calculated between different subgroups classified by different ages （136 cases in 0～y, 323 cases in 2～y, 312 cases in 6～y and 301 cases in 10～18y）. The diagnostic accuracy was analyzed by the area under the curve （AUC）. The criterion for significance was set as P〈0. 05. Results The sensitivity of IGRAs （85.4%, 175/205） was higher than TST test （81.5%, 167/205） in active TB children （X2 =1. 128,P〉0. 05）, especially who were younger than 1 year old （IGRAs： 80.0%, 24/30, TST： 53.3%, 16/30, χ^2 = 0.03,P〉0. 05）, but there was no statistical difference. And the specificity of IGRAs was much higher than that of TST in each of the age subgroups （0～y,99.1% vs. 86.8G ,X2 =12. 125,P〈0.01;2～y,93.9% vs. 73.6%,,χ^2 =41. 603,P〈0.01;6～y,92.2% vs. 77.0% ,X2 =23. 948, P〈 0.01; 10 ～ 18y, 88.8% vs. 65.6%, X2 =33. 040, P〈 0.01 ）. AUC of IGRAs （0.895, 0.882, 0.893） was much higher than that of TST （0.701, 0.770, 0.764） in 0～y, 2～y and 10～18y subgroups （P〈0. 05）, and AUC of the two tests were similar in 6～y subgroup （ IGRAs： 0. 895, TST： 0. 838,P〉 0.05）. The two test obtained low concordance in the enrolled subjects, katapa〈0. 40. The AUC of four tests were no statistical difference （P〉0.05）. The overall proportion of indeterminate results was high （8. 6%, 101/1173）, the indeterminate rate of children older than 9 years old was significant lower than the other three groups （10.5% for 0～y,10.0% for 2～y,8.0% for 6～y,6.8% for 10～18y,χ^2 =859.9,P〈0. 01）. Conclusion

关 键 词：干扰素γ释放试验 结核/诊断 儿童 

分 类 号：R52[医药卫生—内科学]