IGRA与TST在肺结核痰菌阳性患者家庭密切接触者感染的诊断评价  

Efficacy of IGRA and TST in diagnosis of infections in population closely contacted with bacterium-positive tuberculosis patients

作　　者：钟剑峰[1] 童涌[1] 宋群[1] 童照威[1] 王伟洪[1] ZHONG Jian-feng;ToNG Yong;SONG Qun;TONG Zhao-wei;WANG Wei-hong(The Central Hospital of Huzhou, Huzhou, Zhejiang 313000, China)

机构地区：[1]湖州市中心医院感染内科,浙江湖州313000

出　　处：《中华医院感染学杂志》2018年第11期1629-1632,共4页Chinese Journal of Nosocomiology

基　　金：湖州市科技局公益性技术应用研究(重点)基金资助项目(2014GZ10)

摘　　要：目的探讨结核分枝杆菌γ-干扰素体外释放实验(TB-IGRA)与结核菌素皮肤实验(TST)在菌阳肺结核患者家庭密切接触者结核菌感染的诊断效能。方法选择2013年1月-2015年12月医院307例痰涂阳性的新发肺结核患者的家庭密切接触者586例为研究对象,均行外周血结核菌特异性干扰素-γ(IFN-γ)水平、TST平行检测,以胸部X线检查为金标准,比较酶联免疫斑点试验(ELISPOT)和TST诊断效能。结果 586例家庭密切接触者中,经胸部X线检查确诊为活动性结核患者15例,检出率为2.56%;586例家庭密切接触者中,TST检出阳性108例,ELISPOT检出阳性140例,ELISPOT检出阳性率23.89%高于TST阳性率18.43%(P=0.022);ELISPOT、TST≥60岁检出率均高于<60岁(P<0.001);15例确诊活动性结核接触者中,TST检出5例,ELISPOT检出12例。ELISPOT灵敏度为80.00%高于TST 33.33%(P=0.025),两种检测方法特异度、准确度、阳性预测值、阴性预测值比较无统计学意义。结论 TB-IGRA具有更高的灵敏度,可用于筛查及早期诊断菌阳肺结核病人家庭密切接触者结核菌感染。OBJECTIVE To investigate the diagnostic efficacy of TB-IGRA and mycobacterium tuberculosis skin test（TST）in the close contact of tuberculosis patients with tuberculosis-positive tuberculosis.METHODS A total of586 patients with close family contacts of sputum smear positive tuberculosis from Jan.2013 to Dec.2015 were selected.The level of IFN-γin peripheral blood was detected and the tuberculin skin test（TST）was performed in parallel.Chest radiography was taken as the gold standard.The diagnostic efficiency of ELISPOT and TST were compared.RESULTS Among the 586 families with close contacts,15 cases were diagnosed with active tuberculosis by chest X-ray,and the detection rate was 2.56%.Among the 586 families with close contacts,there were 108 positive cases detected by TST,140 positive cases were detected by ELISPOT,and the positive rate of ELISPOT（23.89%）was higher than 18.43% of TST（P=0.022）.that the detection rates of TST and ELISPOT in patients with age≥60 years old were significantly higher than those60 years old（P〈0.001）.Among 15 active tuberculosis patients,5 cases were detected by TST and 12 cases detected by ELISPOT.The sensitivity of ELISPOT was80.00%,which was higher than 33.33% of TST,and the specificity,accuracy,positive predictive value and negative predictive value of the two detection methods had no significance.CONCLUSIONTB-IGRA has a higher sensitivity,which can be used for screening and early diagnosis of bacterium-positive pulmonary tuberculosis patients close contact with family tuberculosis infection.

关 键 词：菌阳肺结核 家庭密切接触者 结核菌素皮肤试验 TB-IGRA 诊断效能 

分 类 号：R521[医药卫生—内科学]