γ-干扰素释放实验在结核病诊断中的应用价值分析  

Application value of interferon-gamma release assays in the diagnosis of tuberculosis

作　　者：王甲甲[1] 唐义斌[1] 张玲英[1] 洪华[1] 谭泰昌[1] 王智斌[1] 

机构地区：[1]四川省医学科学院.四川省人民医院检验科,四川成都610072

出　　处：《分子诊断与治疗杂志》2018年第2期115-119,137,共6页Journal of Molecular Diagnostics and Therapy

摘　　要：目的回顾性分析γ-干扰素释放实验(interferon-gamma release assays,IGRA)在结核病诊断中的应用价值。方法采用结核IGRA(Tuberculosis-IGRA,TB-IGRA)法分别检测111例结核病患者(包括97例肺结核和14例肺外结核)和98例非结核病患者的γ-干扰素释放量,并以临床诊断为标准,评价TB-IGRA诊断结核病(包含涂阴肺结核和肺外结核)的敏感度、特异度、阴性预测值、阳性预测值、诊断准确度;同时对TB-DNA、TB-IgG、结核杆菌培养实验间的一致性进行评价。结果TB-IGRA诊断结核病的敏感度为89.2%,显著高于TB-IgG(35.6%)、结核杆菌培养(40.6%)及结核涂片实验(18.3%)(P均<0.05);而TB-IGRA诊断结核病的特异度(76.5%)低于TB-IgG(96%)、结核杆菌培养(95%)及结核涂片实验(100%)(P均<0.05);TB-IGRA法诊断涂阴肺结核的敏感度(89.6%)高于TB-IgG(32.9%)及结核杆菌培养法(33.3%),而特异度(76.4%)低于TB-IgG(97.9%)及结核杆菌培养法(97.2%)(P均<0.05);且TB-IGRA与TB-IgG、结核杆菌培养实验的诊断结果有差异,且差异有统计学意义(P均<0.05);TB-IGRA与TB-DNA诊断结果的差异无统计学意义(P>0.05)。结论 TB-IGRA具有很高的敏感度,阴性预测值显著高于TB-IgG、结核杆菌培养和结核涂片实验,在结核病的诊断方面具有很高的阴性预测价值。Objective To retrospectively analyze the application value of interferon-gamma release assays （IGRA） in the diagnosis of tuberculosis. Methods The interferon-γ release levels of 111 cases of tuberculosis patients （including 97 cases of pulmonary tuberculosis and 14 cases of extrapulmonary tuberculo- sis） and 98 non-tuberculosis patients were detected by TB-IGRA assay. The clinical diagnosis was used as the standard, to evaluate the sensitivity, specificity, negative predictive value, positive predictive value and accura- cy of TB-IGRA in the diagnosis of tuberculosis （including smear negative pulmonary tuberculosis and extrapul- monary tuberculosis）. Furthermore, TB-DNA, TB-IgG, mycobacterium tuberculosis culture experiment were carried on a portion of the patients to evaluate the consistency among the above experiments. Results The sensitivity of TB-IGRA in the diagnosis of tuberculosis was 89.2%, significantly higher than that of TB-IgG （35.6%, P〈0.05）, mycobacterium tuberculosis culture （40.6%, P〈0.05） and tuberculosis smear （18.3%, P〈0.05）. The specificity of TB-IGRA （76.5%） in the diagnosis of tuberculosis was less than that of TB-IgG （96%）, myco- bacterium tuberculosis culture （95%）, and tuberculosis smear （100%） （all P〈0.05）. The sensitivity of TB-IGRA in the diagnosis of smear-negative tuberculosis was 89.6%, significantly higher than that of TB-IgG （32.9%）, mycobacterium tuberculosis culture （33.3%）, and the specificity of TB-IGRA （76.4%） was less than that of TB-IgG （97.9%）, mycobacterium tuberculosis culture（97.2%） （all P〈0.05）. TB-IGRA can increase the sensitivi- ty of diagnosis for extrapulmonary tuberculosis. The difference in the diagnosis of tuberculosis between TB-IG- RA and TB-IgG, mycobacterium tuberculosis culture were statiscally significant （P〈0.05）; but the comparison between TB-IGRA and TB-DNA revealed no statistical significance （P〉0.05）. Conclusion TB-IGRA has high sensitivity, and higher negative

关 键 词：Γ-干扰素释放试验 结核病 涂阴肺结核 

分 类 号：R446.5[医药卫生—诊断学] R52[医药卫生—临床医学]