干扰素-γ释放试验在诊断血液透析患者结核分枝杆菌感染中的价值  

Interferon-γ release test in the diagnosis of hemodialysis patients with Mycobacterium tuberculosis infection

作　　者：徐明芝[1] 李洪[1] 白亚飞[1] 陈汝满 王宇静[2] XU Mingzhi;LI Hong;BAI Yafei;CHEN Ruman;WANG Yujing(Blood Purification Center,Hainan Provincial People＇s Hospital,Haikou 570311,China;Department of hernodialysis,Haikou Hospital Affiliated to Xiangya Medical College of Central South University,Haikou 570208,China)

机构地区：[1]海南省人民医院血液净化中心,海南海口570311 [2]中南大学湘雅医学院附属海口医院血透科,海南海口570208

出　　处：《西部医学》2018年第9期1340-1343,共4页Medical Journal of West China

基　　金：海南省自然科学基金项目(30843)

摘　　要：目的对结核菌素皮肤试验与干扰素-γ释放试验检测血液透析患者结核分枝杆菌感染的方法进行比较,评价不同方法检测血液透析患者结核分枝杆菌感染的临床应用价值。方法回顾性分析2015年9月~2016年9月200例在医院行血液透析的疑似结核感染患者,用结核菌素皮肤试验(TST)与干扰素-γ释放试验(IGRA)分别检测200例患者,分析比较两种方法诊断血液透析患者结核分枝杆菌感染的阳性率、敏感性、特异性、假阳性率、假阴性率及与卡介苗接种和既往结核感染的相关性。结果两种试验方法阳性检出患者年龄、血液透析时间、有卡介苗疤痕人数、性别等均无统计学差异(P>0.05);IGRA试验检测阳性率显著高于TST试验(P<0.05);IGRA检出阳性率与卡介苗接种史、结核病史均相关(P<0.05),TST检出阳性率与卡介苗接种史具有相关性(P<0.05),但与结核病史不相关(P>0.05)。IGRA敏感性、特异性、假阳性率、假阴性率均优于TST。结论相较于结核菌素皮肤试验,干扰素-γ释放试验检测血液透析患者结核分枝杆菌感染检出阳性率、敏感性、特异性高,假阳性、假阴性率低,可在临床推广应用。Objective To compare the method of tuberculin skin test with interferon-γrelease test to detect the infection of Mycobacterium tuberculosis in hemodialysis patients,evaluate the clinical value of different methods in Mycobacterium tuberculosis infection in hemodialysis patients.Methods 200 hemodialysispatients of suspected tuberculosis infection in our hospital were included in the present study.The Mycobacterium tuberculosis infection positive rate,sensitivity,specificity,false positive,false negative and BCG vaccination and previous tuberculosis infection correlation of the two methods of diagnosis were observed.Results There were no significant differences in age,hemodialysis time,number of BCG scars and sex between the two test methods（P〉0.05）.The positive rate of interferon-γrelease test was significantly higher than that of tuberculin skin test（P〈0.05）.The positive rate of tuberculosis was significantly higher than that of tuberculin skin test（P〈0.05）.The positive rate of IGRA was correlated with BCG vaccination history and tuberculosis history（P0.05）.The positive rate of TST was correlated with BCG vaccination（P〈0.05）,but not correlated with tuberculosis history（P〉0.05）.IGRA sensitivity（97.33%）,specificity（80%）,false positive rate（20%）and false negative rate（2.67%）were better than TST sensitivity（62.37%）,specificity（32.32%）,false positive Rate（67.68%）,false negative rate（37.63%）.Conclusion Compared with tuberculin skin test,interferon-γrelease test to detect hemodialysis patients with Mycobacterium tuberculosis infection has high positive rate,sensitivity and specificity,and has low false positive and false negative rate.

关 键 词：结核菌素皮肤试验 干扰素-γ释放试验 血液透析 结核分枝杆菌感染 

分 类 号：R52[医药卫生—内科学] R459.5[医药卫生—临床医学]