驻京某部队新兵结核潜伏感染人群筛查新方法研究  

A new method for screening latent tuberculosis infection in Beijing army recruits

作　　者：张云林[1] 白雪娟[2] 梁艳[2] 郭景玉[1] 王国营[1] 何柳[1] 杨淑梅[1] 吴雪琼[2] 

机构地区：[1]解放军316医院检验科,北京100091 [2]解放军309医院全军结核病研究所全军结核病防治重点实验室结核病诊疗新技术北京市重点实验室,北京100091

出　　处：《军事医学》2017年第6期462-465,共4页Military Medical Sciences

基　　金：总参军事医学和老年病科研基金资助项目(ZCWS14C03)

摘　　要：目的了解2014年驻京某部队入伍新兵结核感染情况,同时对一种新的结核潜伏感染筛查方法进行评价。方法 194名入伍新兵,行胸部X线检查、结核菌素试验(PPD)、抗体检测,同时应用ELISA联合重组融合蛋白CFP10-ESAT6和潜伏感染蛋白Rv2628进行IGRA检测。结果 PPD皮肤试验和抗体检测的阳性率分别为49.7%和15.5%。CFP10-ESAT6刺激后γ干扰素释放试验(IGRA)检测发现194名新兵中潜伏感染率为22.2%。Rv2628刺激结核潜伏感染(latent tuberculosis infection,LTBI)人群后产生IFN-γ的水平显著高于健康对照(P<0.05),其刺激PPD弱阳性组(5 mm≤皮试直径<15 mm)产生的IFN-γ值显著高于强阳性组(皮试直径≥15 mm)(P<0.05),而CFP10-ESAT6刺激后产生的IFN-γ水平在这两组间差异不显著(P>0.05)。CFP10-ESAT6和Rv2628刺激后产生的IFN-γ水平在抗体阴、阳性组间无显著性差异(P>0.05)。Rv2628诊断结核感染的ROC曲线下面积为0.84,约登指数为0.621,此时特异度为94.7%,敏感度为67.4%。结论联合检测抗原Rv2628及CFP10-ESAT6特异的IFN-γ值在鉴别结核活动或潜伏感染方面具有一定潜能和价值。Objective To investigate the Mycobacterium tuberculosis infections in 2014 among Beijing army recruits,and evaluate a new method for screening latent tuberculosis infections. Methods A total of 194 army recruits were subjected to chest X-ray examination purified protein derivative（ PPD） skin test,antibody detection,and interferon gamma release assay（ IGRA） by ELISA combined with recombinant protein CFP10-ESAT6 and latent infection protein Rv2628.Results The positive rates of PPD skin test and antibody test were 49. 7% and 15. 5%,respectively. The latent infection rate of IGRA test was 22. 2% in 194 cases after CFP10-ESAT6 stimulation. After stimulation of latent tuberculosis infection（ LTBI） with Rv2628,IFN-γ level was significantly higher than that in healthy control group（ P〈 0. 05）. The weak positive group of TST（ 5 mm≤diameter〈 15 mm） had a significantly higher level of IFN-γ than the strong positive group（ diameter≥15 mm）（ P〈 0. 05）,but after stimulation with CFP10-ESAT6,IFN-γ levels were not significantly different between the two groups（ P 〉0. 05）. There was no significant difference between antibody negative and positive groups after stimulation by CFP10-ESAT6 and Rv2628（ P 〉0. 05）. The area under the ROC curve of Rv2628 diagnosis of tuberculosis infection was 0. 84. When Youden index was 0. 621,the specificity was 94. 7% and sensitivity was 67. 4%. Conclusion Combined detection of antigens Rv2628 and CFP10-ESAT6 specific IFN-γ values can be potentially used for differential diagnosis of active or latent tuberculosis infections.

关 键 词：结核潜伏感染 CFP10-ESAT6融合蛋白 Rv2628蛋白 Γ干扰素释放试验 潜伏感染诊断 

分 类 号：R825.2[医药卫生—临床医学]