结核γ干扰素释放试验酶联免疫试管法和结核菌素皮试试验对行维持性血液透析合并结核患者的诊断和预后判断价值研究  

Diagnostic and Prognostic Values of Quantification ELISA Interferon-γ Release Test Assays and Tuberculosis Skin Test for Tuberculosis Patients Undergoing Maintenance Hemodialysis

作　　者：李洪[1] 徐明芝[1] 陈汝满 安娜[1] 白亚飞[1] 黄杏[1] 王春莉 贺纪清 蔡莉[1] 曾欣[1] 韩丽珍[2] LI Hong;XU Mingzhi;CHEN Ruman;AN Na;BAI Yafei;HUANG Xing;WANG Chunli;HE Jiqing;CAI Li;ZENG Xin;HAN Lizhen(Blood Purification Center,Hainan General Hospital,Haikou 570311,China;Information Center,Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院血液净化中心,海南省海口市570311 [2]海南省人民医院信息中心,海南省海口市570311

出　　处：《中国全科医学》2018年第36期4464-4470,共7页Chinese General Practice

基　　金：海南省社会发展科技专项基金(SF201307)

摘　　要：目的探讨结核γ干扰素释放试验酶联免疫试管法(QFT)和结核菌素皮试试验(TST)对结核高流行地区(海南地区)行维持性血液透析(MHD)合并结核[包括隐性结核(LTBI)和结核病]患者的诊断、预后判断价值。方法选择2013—2015年在海南省人民医院血液净化中心行MHD时间>3个月的患者198例,收集患者的一般资料,进行QFT和TST,评估其对MHD合并结核的诊断和预后判断价值。采用多因素Logistic回归分析分析QFT阳性和TST阳性的影响因素。观察患者3年的预后情况,绘制生存曲线,采用Cox比例风险模型分析其预后影响因素。结果最终156例患者完成研究,其中男109例、女47例,平均年龄(54.4±16.6)岁,平均透析龄(1.9±0.4)年。MHD患者QFT阳性率为34.6%(54/156),TST阳性率为67.9%(106/156),TST与QFT结果无一致性(Kappa值=0.053,P=0.405)。多因素Logistic回归分析显示,在校正其他因素的情况下,性别[OR=0.345,95%CI(0.144,0.828),P=0.017]、有无卡介苗接种瘢痕[OR=0.345,95%CI(0.144,0.828),P=0.017]是QFT阳性的影响因素;性别[OR=2.836,95%CI(1.120,7.177),P=0.028]、淋巴细胞分数[OR=3.573,95%CI(1.410,12.295),P=0.043]是TST阳性的影响因素。37例LTBI患者中11例转为肺结核(29.7%)。本组患者3年结核患病率为42 948.7/10万。MHD患者1、2、3年生存率分别为89.7%、77.6%、69.9%,粗死亡率(CDR)为301.3/1 000人。Cox比例风险模型分析发现QFT阳性、C反应蛋白升高是生存的不利因素;抗结核治疗、前清蛋白升高是生存的有利因素(P<0.05)。结论在海南地区,男性MHD患者QFT阳性率较高;TST与QFT对MHD合并结核的诊断无一致性。QFT阳性、C反应蛋白升高是生存的不利因素,抗结核治疗、前清蛋白升高是生存的有利因素。在结核高流行地区MHD患者合并LTBI、结核病的诊断依然需要结合流行病学、病史、结核易感因素、肺部影像学,排除其他感染,行试验性抗结核治疗,需大力推进组织病理、肺支气ObjectiveTo study the diagnostic and prognostic values of quantification ELISA interferon-γ release test（QFT） and tuberculosis skin test（TST） for patients with tuberculosis〔including both latent tuberculosis infection（LTBI） and tuberculosis（TB）〕 undergoing maintenance hemodialysis（MHD） in areas with high prevalence of tuberculosis.MethodsTotaled 198 patients who underwent MHD in Blood Purification Center,Hainan General Hospital,for more than 3 months during 2013-2015 were enrolled.All of them were given a 3-year follow-up.Baseline clinical data were collected.The results of QFT and TST were also obtained and their values in the diagnosis and prediction of the prognosis of these patients were evaluated.Multivariate Logistic regression analysis was performed to investigate the influencing factors for positive results of QFT and TST.The prognosis of patients in 3 years was observed,and survival curves were drawn.Cox proportional hazards regression analysis was carried out to explore the factors associated with the prognosis.Results156 cases who completed the study were included in the final analysis,including 109 males and 47 females,with an average age of （54.4±16.6）years and an average hemodialysis duration of （1.9±0.4） years.The prevalences of positive QFT,positive TST were 34.6%（54/156）,67.9%（106/156）,respectively.The results of TST and QFT in identifying TB showed no consistency（Kappa=0.053,P=0.405）.Multivariate Logistic regression analysis revealed that,after adjusting for other factors,sex〔OR=0.345,95%CI（0.144,0.828）,P=0.017〕and no BCG vaccine scar〔OR=0.345,95%CI（0.144,0.828）,P=0.017〕were risk factors for having a positive QFT result,the sex 〔OR=2.836,95%CI（1.120,7.177）,P=0.028〕and the total lymphocyte count〔OR=3.573,95%CI（1.410,12.295）,P=0.043〕were risk factors for having a positive TST result.Of the 37 patients identified with LTBI,11（29.7%） developed TB.The 3-year prevalence of TB in these patients was 42 948.7/100 000.The 1

关 键 词：血液透析 结核 Γ干扰素释放试验 结核菌素皮试试验 

分 类 号：R52[医药卫生—内科学]