γ-干扰素释放试验在活动性肺结核诊断中的价值  

Clinical value of interferonγrelease assay in diagnosis of active pulmonary tuberculosis

作　　者：黄德东 刘庭贵 张云 施洁 韩湉湉 庄建文 魏西飞 顾兴 Huang Dedong;Liu Tinggui;Zhang Yun;Shi Jie;Han Tiantian;Zhuang Jianwen;Wei Xifei;Gu Xing(Department of Infectious Diseases, 903rd Hospital of PLA, Hangzhou 310013, China;Department of Infectious Diseases, Zhijin County People′s Hospital, Zhijin 552100, Guizhou Province, China;Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi′an 710038, China)

机构地区：[1]解放军联勤保障部队第903医院感染科,杭州310013 [2]贵州省织金县人民医院感染科,织金552100 [3]西安市胸科医院呼吸与危重症医学科,西安710100

出　　处：《中华肺部疾病杂志（电子版）》2020年第3期329-333,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：浙江省自然科学基金资助项目(LY15H9001);浙江省医药卫生科技计划项目(2016KYB248);解放军联勤保障部队第903医院帮扶织金县人民医院项目(2020-01)。

摘　　要：目的在我国西南部结核病高发区,评价结核γ-干扰素释放试验(tuberculosis interferonγrelease assay,TB-IGRA)在疑似肺结核中诊断活动性肺结核的价值。方法纳入2018年12月20日至2019年12月20日在贵州省织金县人民医院诊断的疑似肺结核患者1627名,用TB-IGRA、结核菌素皮肤实验(TST)、结核分枝杆菌抗体(TBAb)或结核分枝杆菌免疫球蛋白(TB-Ig)检测诊断活动性肺结核,比较其敏感性、特异性、准确性。并分析卡介苗(Bacillus Calmette-Guérin,BCG)接种对结果的影响。结果TB-IGRA的敏感性、特异性和准确性,依次为:91.26%、80.13%和89.37%,均高于TST、TB-IgG的检测。TB-IGRA诊断疑似肺结核中的活动性肺结核,不受BCG接种的影响(χ2=0.05,P=0.83)。BCG接种对TST诊断疑似肺结核中的活动性肺结核影响明显(χ2=108.17,P<0.001)。结论TB-IGRA在我国西南部结核病高发区诊断活动性肺结核有很高的敏感性、特异性,较TST、TB-Ig有更高价值,且不受BCG接种的影响。Objective To evaluate the clinical value of tuberculosis interferonγrelease assay(TB-IGRA)in the diagnosis of active pulmonary tuberculosis among the suspected pulmonary tuberculosis patients in the southwest region of China with high TB burden.Methods A total of 1627 suspected pulmonary tuberculosis patients from the Department of Infectious Diseases of Zhijin County People′s Hospital in Guizhou Province in China between December 20,2018 and December 20,2019 were enrolled for this study.Then TB-IGRA,tuberculin skin test(TST)and tuberculosis immunoglobulin(TB-Ig)were used respectively to diagnose the active pulmonary tuberculosis.And the sensitivity,specificity and accuracy were compared among the patients with TB-IGRA,TST,and TB-Ig,respectively.The influences of Bacillus Calmette-Guérin(BCG)vaccination on these tests were analyzed.Results The sensitivity,specificity and accuracy of TB-IGRA were 91.26%,80.13%,and 89.37%,respectively,and they were higher than those of TST or TB-IgG.The results of TB-IGRA diagnosis for active pulmonary tuberculosis among the suspected pulmonary tuberculosis patients were not affected by BCG vaccination(χ2=0.05,P=0.83).However,BCG vaccination affected the results of TST significantly(χ2=108.17,P<0.001).Conclusion TB-IGRA seems to be superior to TST or TB-IgG as a diagnostic tool for the detection of active pulmonary tuberculosis among the suspected pulmonary tuberculosis patients in southwest region of China with high TB burden and it is not affected by BCG vaccination.

关 键 词：结核γ-干扰素释放试验 结核菌素试验 结核分枝杆菌抗体 

分 类 号：R563[医药卫生—呼吸系统]