结核分枝杆菌γ－干扰素释放试验与人类白细胞分化抗原G联合检测肺结核的诊断效能评价  

The diagnostic efficiency evaluation of combination tuberculosis interferon-gamma release assay with human leukocyte antigen-G for tuberculosis

作　　者：吕秋琼[1] 许文芳 王琼 尉理梁 陶叶海 杨小林 董惠倩 陶志华[1] 

机构地区：[1]浙江大学医学院附属第二医院检验科,杭州310009 [2]绍兴市立医院检验科 [3]绍兴市立医院呼吸内科

出　　处：《中华检验医学杂志》2016年第11期852-856,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨肺结核患者外周血特异性T细胞IFN－γ（TB－IGRA）和人类白细胞分化抗原G（HLA－G）的表达情况及其诊断肺结核的价值。 方法 采用回顾性研究设计方法，病例均来自2015年1月至12月绍兴市立医院呼吸科就诊的肺部疾病患者，根据临床和病理诊断分为肺结核组（34例）、肺癌组（25例）及非结核性肺炎组（25例），以及35名健康体检者入选为表观健康组，ELISA法检测结核特异性T细胞IFN－γ和sHLA－G的表达，流式细胞分析法检测mHLA－G的表达，Kruskal－Wallis检验比较组间差异，各项指标诊断肺结核的价值用ROC曲线分析。 结果 肺结核患者TB－IGRA、sHLA－G和mHLA－G表达量的中位数分别为182.5 ng/L、99.44 U/ml和13.63%，高于肺癌（117.0 ng/L、82.3 U/ml和9.12%）、肺炎（80.84 ng/L、34.2 U/ml和10.92%）和健康组（30.5 ng/L、31.28 U/ml和8.18%）（P值〈0.05）。TB－IGRA、sHLA－G和mHLA－G诊断肺结核的ROC曲线下面积分别为0.842（95% CI：0.761～0.922）、0.746（95% CI：0.652～0.840）和0.706（95% CI：0.605～0.806）。当TB－IGRA、sHLA－G和mHLA－G的诊断界值分别为35 ng/L、60 U/ml和10%时，敏感性分别为88.24%、70.59%和67.65%，特异性分别为60%、72.94%和70.59%。3项指标联合检测的敏感性和特异性为88.24%和81.18%。 结论 肺结核患者结核特异性T细胞IFN－γ和HLA－G表达量均增加，虽然外周血中TB－IGRA检测具有较高的诊断价值，但与HLA－G联合检测显著提高诊断特异性，对肺结核的诊断具有一定临床应用价值。To study the expression of IFN-γ by tuberculosis specific T cells（TB-IGRA）and Human Leukocyte Antigen-G（HLA-G） in the peripheral blood of tuberculosis patients and its diagnostic value in tuberculosis. MethodsThis was a retrospective cohort study. Study cases were all from Resparation Department of Shaoxing Municipal Hospital from January 2015 to December 2015. These patients were devided into tuberculosis group（TB） （34 cases）, lung cancer group（LCa） （25cases） and non tuberculous pneumonia group（Non-TB pneumonia） （25cases） according to diagnosis, meanwhile, health group （35 cases） was set. IFN-γ and sHLA-G were detected by ELISA , and mHLA-G was detected by Flowcytometre. The receiver operating characteristic curve（ROC） was used to evaluate the diagnostic efficacy of TB-IGRA, sHLA-G and mHLA-G. ResultsThe expression of TB-IGRA, sHLA-G and mHLA-G were higher in the TB group （with the median of 182.5 ng/L, 99.44 U/ml and 13.63%） than in the LCa group （117.0 ng/L, 82.3 U/ml and 9.12%）, Non-TB pneumonia group（80.84 ng/L, 34.2 U/ml and 10.92%） and health group（30.5 ng/L, 31.28 U/ml and 8.18%）（P〈0.05）. The AUC-ROC of TB-IGRA, sHLA-G and mHLA-G were 0.842（95% CI, 0.761-0.922）, 0.746（95% CI, 0.652-0.840） and 0.706（95% CI, 0.605-0.806）. The sensitivity for TB-IGRA, sHLA-G and mHLA-G was 88.24%, 70.59% and 67.65%, and the specificity was 60%, 72.94% and 70.59% at the cutoff value of 35 ng/L, 60 U/ml and 10% respectively. The sensitivity and specificity of combination detection for TB-IGRA and HLA-G were 88.24% and 81.18%. ConclusionsTB-IGRA, sHLA-G and mHLA-G were all increased in TB, while, the quantitative detection of TB-IGRA is more helpful for diagnosis. The combination detection of TB-IGRA, sHLA-G and mHLA-G can improve the sensitivity in the diagnosis of tuberculosis.

关 键 词：结核 肺 结核分枝杆菌 干扰素γ释放试验 HLA-G抗原 

分 类 号：R521[医药卫生—内科学] R446.6[医药卫生—临床医学]