两种γ-干扰素释放试验在结核性胸膜炎中的辅助诊断价值  

Comparison of two interferon-gamma release assay for diagnosis of tuberculous pleurisy

作　　者：贾红彦[1] 潘丽萍[1] 杨新婷[2] 杜博平 孙琦[1] 魏荣荣[1] 邢爱英[1] 陈效友[2] 张宗德[1] Jia Hongyan;Pan Liping;Yang Xinting;Du Boping;Sun Qi;Wei Rongrong;Xing Aiying;Chen Xiaoyou;Zhang Zongde(Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing 101149, China)

机构地区：[1]首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所耐药结核病研究北京市重点实验室,101149 [2]首都医科大学附属北京胸科医院结核科,101149

出　　处：《北京医学》2018年第4期297-300,I0001,共5页Beijing Medical Journal

基　　金：北京市医院管理局临床医学发展专项--“扬帆”计划(ZYLX201304);北京市医院管理局登峰人才计划(DFL20181601);国家科技重大专项(2015ZX10004801-003,2017ZX10201301-004);北京市重大传染病防治协同创新中心(PXM2016_014226_000052);北京市通州区科技计划(KJ2017CX076)

摘　　要：目的评价基于外周血单个核细胞的酶联免疫斑点试验(T-SPOT.TB)和基于全血的酶联免疫吸附试验(Quanti FERON-TB Gold in-tube,QFT-GIT)在结核性胸膜炎中的辅助诊断价值。方法收集2016年12月至2017年12月在首都医科大学附属北京胸科医院住院确诊的胸腔积液患者60例(除临床诊断和未确诊病例122例),其中结核性胸膜炎37例(结核组),非结核性胸膜炎23例(对照组),同时行胸腔积液和外周血T-SPOT.TB和QFT-GIT检测。结果胸腔积液和外周血中,结核组T-SPOT.TB斑点形成细胞(spot forming cell,SFC)数与QFT-GIT检测的IFN-γ释放量值均明显高于对照组,差异均有统计学意义(P<0.01);结核组中胸腔积液T-SPOT.TB检测的SFC数显著高于外周血SFC数,差异有统计学意义(P<0.01)。胸腔积液T-SPOT.TB检测的ROC曲线下面积(AUC)为0.932,高于外周血QFT-GIT检测(0.874)、外周血T-SPOT.TB检测(0.855)和胸腔积液QFT-GIT检测(0.779)。胸腔积液T-SPOT.TB检测中不确定结果比例(16.7%)显著低于QFT-GIT(46.7%),差异均有统计学意义(P<0.01)。结论 T-SPOT.TB检测方法更适用于胸腔积液的检测,可辅助结核性胸膜炎的早期诊断。Objective To evaluate the performance of two interferon-gamma release assays （T-SPOT.TB and QFT- GIT） for diagnosis of tuberculous pleurisy. Methods From Dec 2016 to Dec 2017, 60 patients in Beijing Chest Hospital were enrolled and categorized as tuberculous pleurisy （TB group, n=37） and non-tuberculous pleurisy （NTB group, n=23）, the remaining inconclusive TB and clinical diagnosis TB （n= 122） were excluded from final analysis. T-SPOT.TB and QFT- GIT on pleural fluid were performed in paralleled with peripheral blood. Results Both the SFCs and the concentration of IFN-γ were significantly higher in the TB group than those in the NTB group. In the TB group, there was a significant difference between SFCs using T-SPOT.TB in pleural fluid and peripheral blood. The area under the ROC curve （AUC） of pleural fluid T-SPOT.TB test was 0.932, which was higher than peripheral blood QFT-GIT （0.874）, peripheral blood T-SPOT.TB （0.855） and pleural fluid QFT-GIT （0.779）. Less indeterminate results were detected in pleural fluid T-SPOT.TB test （16.7%） than that in pleural fluid QFT-GIT test （46.7%, P 〈 0.01）. Conclusion T-SPOT.TB test is better than QFT- GIT test on pleural fluid as a useful adjunctive tool for diagnosis of tuberculous pleurisy.

关 键 词：结核性胸膜炎 胸腔积液 T-SPOT.TB QFT-GIT Γ-干扰素释放试验 

分 类 号：R521.7[医药卫生—内科学]