γ-干扰素释放试验联合胸腔积液腺苷脱氨酶检测对结核性胸膜炎的辅助诊断价值  

Value of the blood interferon-y release assay combined with the hydrothorax adenosine deaminase detection in the diagnosis tuberculous pleural

作　　者：于永敏[1] 任鹏飞[2] 程俊伟[2] 陈永芳[2] 马峥[2] 李瑞[2] 陈裕[2] 

机构地区：[1]郑州市第六人民医院检验科,450015 [2]郑州市第六人民医院结核科,450015

出　　处：《中国防痨杂志》2016年第11期1007-1009,共3页Chinese Journal of Antituberculosis

基　　金：郑州市普通科技攻关计划（131PPTGG383-2）

摘　　要：选取2012年1月至2013年12月在郑州市第六人民医院结核科住院的渗出性胸腔积液患者120例，经临床综合诊断分为结核性胸膜炎患者79例（病例组），非结核性胸膜炎患者4l例（对照组）。采集患者静脉血和胸腔积液，进行γ-干扰素释放试验（IGRA）与胸腔积液腺苷脱氨酶（ADA）检测。最终，以血IGRA检测联合胸腔积液ADA检测均为阳性作为结核性胸膜炎辅助诊断时，特异度为97．56％（40／41），与血IGRA和胸腔积液ADA单项检测的特异度[分别为95．12％（39／41）、90．24％（37／41）]比较，差异均无统计学意义（X^2值分别为19．99、9．48，P值分别为1．000、0．250）；其阳性预测值为98．53％，均高于单项检测的97．44％和94．52％；阳性似然比为34．77，高于各单项检测的19．72和8．95，说明其可降低误诊率。以血IGRA检测联合胸腔积液ADA检测均为阴性作为非结核性胸膜炎辅助诊断时，敏感度为98．73％（78／79），与血IGRA检测敏感度[96．20％（76／79）]比较差异无统计学意义（X^2=25．66，P=0．500）；高于胸腔积液ADA检测的敏感度[87．34％（69／79）]，差异有统计学意义（X^2=6．99，P=0．041）；其阴性预测值为97．30％，均高于各单项检测的92．86％和78．72％；阴性似然比为0．01，低于各单项检测的0．04和0．14，说明其可降低漏诊率。研究结果表明，血IGRA检测联合胸腔积液ADA检测在结核性胸膜炎诊断中有较好的临床应用价值。A total of 120 patients with exudative pleural effusion hospitalized in the Tuberculosis Department of the Sixth Peopl＆s Hospital of Zhengzhou from January 2012 to December 2013 were selected, 79 patients were with tuberculous pleural effusions and 41 patients with non-tuberculous pleural effusions. All the patients were tested with the peripheral blood interferon gamma concentration and the hydrothorax adenosine deaminase （ADA） activity respectively. The specificity of the blood interferon-y release assay （IGRA） combined with the hydrothorax adenosine deaminase detection was 97.56 % （40/41）, with no statistically significant difference compared with single detection （IGRA 95.12% （39/41）, ADA 90. 24% （37/41） ;Zz values were 19.99 and 9.48, P values were 1. 000 and 0. 250）, but the positive predictive value （98.53%） and positive likelihood ratio （34. 77） were higher than those of IGRA （97.44%, 19.72） and ADA （94.52%, 8. 95）, indicating that it could reduce the misdiagnosis rate. The sensitivity of the combined test was 98. 73% （78/79） with no statistically significant difference compared with IGRA （96.20% （76/79）） （;（2= 25.66, P= 0. 500）, but statistically different from that of ADA （87.34% （69/79）） （X^2= 6.99, P= 0.041）; meanwhile, the negative predictive value （97.30%） was higher than that of IGRA （92.86%） and ADA （78.72%）, the negative likelihood ratio （0. 01） was less than that of IGRA （0. 04） and ADA （0.14）, indicating that the combined test could reduce the rate of misdiagnosis. Compared to single detection, IGRA combined with the hydrothorax ADA detection has more important value in diagnosis of tuberculous pleural effusion.

关 键 词：结核 胸腔积液 干扰素Γ 腺苷脱氨酶 

分 类 号：R561.3[医药卫生—呼吸系统]