结核分枝杆菌相关γ-干扰素定量检测在脊柱结核诊断中的应用  

Application of Mycobacterium tuberculosis-related interferon-γ release assay for diagnosis of spinal tuberculosis

作　　者：康新桂 周海洋 徐娟丽 周飞[1] 王中兴[1] 王睿[1] KANG Xin-gui;ZHOU Hai-yang;XU Juan-li;ZHOU Fei;WANG Zhong-xing;WANG Rui(Department of Orthopaedics,Nanjing Integrated Traditional Chinese and Western Medicine Hospital,Nanjing 210014,Jiangsu,China)

机构地区：[1]南京市中西医结合医院骨科

出　　处：《脊柱外科杂志》2020年第1期14-18,共5页Journal of Spinal Surgery

基　　金：南京市2016年度科技发展计划项目(201605057)

摘　　要：目的探讨结核分枝杆菌相关γ-干扰素定量检测(TB-IGRA)在脊柱结核诊断中的应用价值。方法分析44例疑似脊柱结核病例资料,结合最终临床诊断,分为脊柱结核组和非脊柱结核组,计算TB-IGRA、抗结核抗体(TB-Ab)检测、利福平耐药实时荧光定量核酸扩增检测(Xpert MTB/RIF)及病理学检测4种方法诊断脊柱结核的灵敏度、特异度、阳性预测值和阴性预测值,采用kappa一致性检验评估TB-IGRA与TB-Ab检测、Xpert MTB/RIF及病理学检测结果的一致性。结果纳入的44例患者中,确诊或高度怀疑脊柱结核病28例,确诊非脊柱结核16例。TB-IGRA的灵敏度、特异度、阳性预测值和阴性预测值分别为85.7%、68.8%、82.8%和73.3%;TB-Ab检测的灵敏度、特异度、阳性预测值和阴性预测值分别为53.6%、87.5%、88.2%和51.9%;Xpert MTB/RIF的灵敏度、特异度、阳性预测值和阴性预测值分别为68.8%、71.4%、84.6%和50.0%;病理学检测的灵敏度、特异度、阳性预测值和阴性预测值分别为92.9%、100%、100%和88.9%。TB-IGRA与TB-Ab诊断结果一致性较差(κ=0.25),与Xpert MTB/RIF及病理学诊断结果一致性较高(κ=0.68、0.71)。结论TB-IGRA作为脊柱结核的辅助诊断手段,简便、快速,灵敏度和特异度较高,尤其适用于不方便获取病灶组织的患者。Objective To investigate the diagnostic value of Mycobacterium tuberculosis-related interferon-γ release assay(TB-IGRA)for spinal tuberculosis.Methods The recorded clinical data of 44 suspected patients with spinal tuberculosis were divided into spinal tuberculosis group and non-spinal tuberculosis group according to the final clinical diagnosis.The sensitivity,specificity,positive predictive value and negative predictive value of TB-IGRA,tuberculosis antibody(TB-Ab)test,Xpert Mycobacterium tuberculosis/rifampicin(Xpert MTB/RIF)and pathological examination were compared.The consistency of TB-IGRA with TB-Ab test,Xpert MTB/RIF and pathological results was assessed by kappa consistency test.Results Of the 44 patients,28 were diagnosed or highly suspected of having spinal tuberculosis,and 16 were diagnosed without spinal tuberculosis.Sensitivity,specificity,positive predictive value,and negative predictive value of TB-IGRA were 85.7%,68.8%,82.8% and 73.3%,respectively,those of TB-Ab test were 53.6%,87.5%,88.2% and 51.9%,respectively,and those of Xpert MTB/RIF were 68.8%,71.4%,84.6% and 50%,respectively,those of pathological examination were 92.9%,100%,100% and 88.9%,respectively.The consistency between TB-IGRA and TB-Ab test was poor(κ=0.25),and the consistency between TB-IGRA and Xpert MTB/RIF or pathological examination was good(κ=0.68,0.71,respectively).Conclusion The TB-IGRA is a simple and rapid method for auxiliary diagnosis of spinal tuberculosis with good sensitivity and specificity,which is especially suitable for patients who is inconvenient to obtain lesion tissue.

关 键 词：结核 脊柱 干扰素Ⅱ型 诊断技术和方法 

分 类 号：R529.2[医药卫生—内科学]