肺泡灌洗液γ-干扰素释放试验对肺结核诊断的价值  

Value ofγ-interferon release test in bronchoalveolar lavage for diagnosis of pulmonary tuberculosis

作　　者：李晓倩 梁亚充 池跃朋[1] 王玉红[1] 谢兰品[1] 王智慧[1] LI Xiao-qian;LIANG Ya-chong;CHI Yue-peng;WANG Yu-hong;XIE Lan-pin;WANG Zhi-hui(Hebei Chest Hospital,Shijiazhuang,Hebei 050041,China)

机构地区：[1]河北省胸科医院,河北石家庄050041

出　　处：《中国热带医学》2021年第9期845-848,共4页China Tropical Medicine

基　　金：河北省医学科学研究重点课题(No.20200027)。

摘　　要：目的探讨肺泡灌洗液γ-干扰素释放试验在肺结核诊断中的价值。方法选择2020年5月—2021年1月于河北省胸科医院就诊的可疑肺结核患者97例为研究对象,以酶联免疫斑点试验(enzymelinked immunospot assay,ELISpot)检测两组患者全血及肺泡灌洗液γ-干扰素释放试验的差异,探讨肺泡灌洗液γ-干扰素释放试验对肺结核的诊断价值。结果两组患者性别、年龄差异无统计学意义(P>0.05)。活动性肺结核组血和肺泡灌洗液-γ干扰素释放试验的敏感度、特异度、阳性预测值、阴性预测值分别为90.0%(45/50)和92.0%(46/50)、53.8%(21/39)和76.9%(30/39)、71.4%(45/63)和83.6%(46/55)、80.8%(21/26)和88.2%(30/34)。非结核组血和肺泡灌洗液γ-干扰素释放试验阳性率为46.2%(18/39)和23.1%(9/39),与活动性肺结核组比较,差异均有统计学意义(P<0.01)。活动性肺结核组血和肺泡灌洗液培养滤液蛋白γ-干扰素释放试验斑点数分别为(56.66±13.38)和(80.86±16.65),差异有统计学意义。既往结核病史及肺结核接触史能提高血γ-干扰素释放试验的阳性率,而对肺泡灌洗液γ-干扰素释放试验则无。结论肺泡灌洗液γ-干扰素释放试验在活动性肺结核诊断中敏感度及特异度均较高,且不受既往肺结核病史及结核接触史的影响,更能体现肺结核的活动性。Objective To investigate the value of BAL ELISpot in the diagnosis of pulmonary tuberculosis.Methods This study included in 97 patients of suspected pulmonary tuberculosis in Hebei Chest Hospital from May 2020 to January 2021.We collected the results of both blood and BAL ELISpot,then compared the differences between the two group,evaluated the value of BAL ELISpot for diagnosis of pulmonary tuberculosis.Results There were no significant differences in gender and age between two groups(P>0.05).The sensitivity,specificity,positive predictive value and negative predictive value of blood ELISpot in the diagnosis of pulmonary tuberculosis were respectively 90.0%(45/50),53.8%(21/39),71.4%(45/63),80.8%(21/26);and those of BAL ELISpot were respectively 92.0%(46/50),76.9%(30/39),83.6%(46/55),88.2%(30/34).There were significant differences in positive rates of interferon gamma release test 46.2%(18/39),respectively in blood,and 23.1%(9/39)in BAL ELISpot between active pulmonary tuberculosis group and non-TB group(P<0.01).The spots number of interferon gamma release test in alveolar lavage fluid and blood in the active pulmonary tuberculosis group was(80.86±46.65)and(56.66±43.38),respectively,and the difference was statistically significant.History of tuberculosis and pulmonary tuberculosis exposure were risk factors for blood interferon gamma release test,but alveolar lavage fluid interferon gamma release test results were not associated with either.Conclusion The BAL ELISpot has higher sensitivity and specificity in the diagnosis of active tuberculosis,and the BAL ELISpot is more valuable in distinguishing activity of tuberculosis and LTBI.

关 键 词：肺结核 Γ-干扰素 肺泡灌洗液 全血 酶联免疫斑点法 

分 类 号：R521.1[医药卫生—内科学]