γ干扰素释放试验与结核菌素皮肤试验应用于人群结核潜伏性感染诊断的比较  

Comparison analysis of interferon-γ release assay and the tuberculin skin test to detect latent tuberculosis infection

作　　者：丁晓艳[1] 陆伟[1] 刘巧[1] 卢鹏 彭红[1] 陈诚[1] 周扬[1] 宋红焕[1] DING Xiao-yan;LU Wei;LIU Qiao;LU Peng;PENG Hong;CHEN Cheng;ZHOU Yang;SONG Hong-huan(Jiangsu Provincial Center for Disease Control and Prevention , Jiangsu Nanjing 210009,China)

机构地区：[1]江苏省疾病预防控制中心,江苏南京210009

出　　处：《江苏预防医学》2018年第3期237-240,327,共5页Jiangsu Journal of Preventive Medicine

基　　金：国家科技重大专项"艾滋病和病毒性肝炎等重大传染病防治"(2013ZX10103004-002-004)

摘　　要：目的了解江苏省结核潜伏性感染情况,同时对γ干扰素释放试验(interferon-gamma release assays,IGRAs)和结核菌素皮肤试验(tuberculin skin test,TST)2种检测方法进行分析比较,探索适合本省人群特征的结核潜伏性感染的实验室诊断标准。方法整群抽取江苏省丹阳市2个村居民,对符合入选标准的受试者进行问卷调查和常规体格检查,采集静脉血,以QFT法进行γ-干扰素释放试验,后进行结核菌素皮内注射(PPD皮试),及DR胸片检查,对2种方法结果进行描述性分析和一致性分析。结果 QFT检测和PPD皮试(以硬结平均直径≥10mm为阳性评价标准)阳性率分别为18.0%、40.0%。随着年龄增长,QFT检测阳性率逐渐升高;而PPD皮试阳性率先逐渐升高,30~岁年龄组阳性率最高,而后逐渐降低。有瘢痕者QFT法检测阳性低于无瘢痕者,而PPD皮试阳性率大于无瘢痕(P值均<0.01)。以PPD皮试硬结平均直径≥10mm为阳性评价标准时,2种检测方法一致率为69.6%,Kappa值(95%CI)为0.30(0.28,0.33)。随着年龄增长:2种方法结果一致率先降后升,30~岁组最低(49.2%),60~65岁组最高(80.5%);Kappa值逐渐升高,其中5~岁、20~岁等年龄组Kappa值<0.1,而50~、60~65岁等年龄组Kappa值>0.5。结论 50~65岁年龄组TST和IGRAS 2种检测方法一致性较好,<50岁年龄段2种方法一致性较差。TST检测结果可能高估了潜伏感染率,需要建立一种更准确高效、操作方便、价格合理的检测方法以诊断结核潜伏性感染。Objective To investigate the latent tuberculosis infection situation in Jiangsu province;to compare interferon-γrelease assay and the tuberculin skin test to detect latent tuberculosis infection in order to search a suitable laboratory diagnosis standard for latent tuberculosis infection in Jiangsu province.Methods Cluster sampling method was used to choose all residents in 2 villages in Danyang of Jiangsu province.Participants who met the inclusion criteria were given questionnaires and regular physical examinations.Venous blood was collected for interferon-γrelease assay by QFT test,followed by tuberculin skin test（PPD skin test）and X-ray examination.The results of 2 methods were compared.Results The positive rate of QFT test and PPD skin test（diametercutoff=10 mm）was 18.0% and 40.0%,respectively.With the increase of age,positive rates for QFT test increased gradually,while positive rates for PPD skin test gradually increased at first,then gradually decreased with a high peak in the 30-40 age group.The positive rate of QFT test was significantly lower in participants with scars than those without scars,while the positive rate of PPD skin test was significantly higher than those without scars（all P0.01）.For PPD skin test,using diametercutoff=10 mm as standard,the overall coherency between 2 methods was 69.6%;Kappa coefficient was 0.30（95%CI：0.28-0.33）.The coherency between 2 methods gradually decreased with age at first,then gradually increased,the lowest coherency was observed in the 30-40 age group（49.2%）,while the highest coherency was achieve at 60-65 age group.Kappa coefficients were less than 0.1 among participants aged younger than 30 years and were more than 0.5 in participants aged 50 years or older.Conclusion There was a good consistency between the two detection methods of TST and IGRA in the 50-65 years old age group.The consistency is poor for participants in age group younger than 50 years.The results of TST detection may overestimate the latent infection rate.It is necessar

关 键 词：结核杆菌 感染 诊断 结核菌素试验 Γ干扰素释放试验 一致性检验 

分 类 号：R52[医药卫生—内科学]