结核分枝杆菌γ-干扰素释放试验与胸水生化项目联合检测对诊断结核性胸腔积液的价值  

Diagnostic efficacy of Mycobacterium tuberculosisγ-interferon release assay combined with pleural effusion biochemical test for tuberculous pleural effusion

作　　者：郭飞[1] 刘艳清 莫翼军[1] 吴爱华 王姗姗 房树玉 GUO Fei;LIU Yan-qing;MO Yi-jun;WU Ai-hua;WANG Shan-shan;FANG Shu-yu(Clinical Laboratory,Ningbo First Hospital,Ningbo,Zhejiang 315010,China)

机构地区：[1]宁波市第一医院检验科,浙江315010

出　　处：《中国卫生检验杂志》2022年第21期2648-2651,共4页Chinese Journal of Health Laboratory Technology

摘　　要：目的探讨结核性胸腔积液患者外周血特异性T细胞γ-干扰素(TB-IGRA)和胸水腺苷酸脱氨酶(ADA)、乳酸脱氢酶(LDH)、总蛋白(TP)及白蛋白(ALB)联合检测诊断结核性胸腔积液的价值。方法2015年1月—2021年6月宁波市第一医院呼吸科就诊的肺部疾病患者,根据临床和病理诊断分为结核性胸腔积液组(161例)、肺炎性胸腔积液组(138例)、肺癌性胸腔积液(85例),对各组进行全血TB-IGRA试验及检测胸水ADA、LDH、TP及ALB含量,TBIGRA单独及与ADA、LDH、TP及ALB联合检测诊断结核性胸腔积液用ROC曲线分析。结果结核性胸腔积液患者外周血TB-IGRA表达量高于肺炎性胸腔积液和肺癌性胸腔积液(P<0.05);结核性胸腔积液组胸水中ADA、LDH、TP及ALB表达量的中位数高于肺炎性胸腔积液及肺癌性胸腔积液(P<0.05)。TB-IGRA诊断结核性胸腔积液的ROC曲线下面积为0.852(95%CI:0.811~0.892)。当TB-IGRA的诊断界值分别为26.5 pg/ml时,敏感度为83.9%和特异度为78.9%。五项指标联合检测AUC为0.902,其敏感度和特异度分别为87.6%和81.6%。结论结核性胸腔积液患者结核特异性T细胞IFN-γ和胸水ADA、LDH、TP及ALB表达量均增加,外周血TB-IGRA试验与胸水ADA、LDH、TP及ALB联合检测显著提高诊断灵敏度与特异度,对结核性胸腔积液的辅助诊断具有良好的临床应用价值。Objective To investigate the value of combined detection of peripheral blood specific T cell gamma interferon(TB-IGRA)and pleural effusion adenylate deaminase(ADA),lactate dehydrogenase(LDH),total protein(TP)and albumin(ALB)in the diagnosis of tuberculous pleural effusion.Methods Patients collected from the Respiratory Department of Ningbo First Hospital from January 2015 to June 2021 were divided into tuberculosis pleurisy effusion group(TPE,n=161),pneumonia pleural effusion group(PPE,n=138)and lung carcinoma pleural effusion group(LPE,n=85),according to clinical and pathological diagnosis.The whole blood TB-IGRA test and the content detection of ADA,LDH,ALB and TP in pleural effusion were carried out in each group.The values of single TB-IGRA test and its combined tests of ADA,LDH,ALB and TP in diagnosing tuberculous pleural effusion were analyzed by ROC curve.Results The expression of TB-IGRA was higher in the TPE group than that in PPE group and LPE group(P<0.05).And the expression of ADA,LDH,TP and ALB were higher in the TPE group than the PPE group and the LPE group.The area under curve(AUC)of TB-IGRA in the diagnosis of tuberculous pleural effusion was 0.852(95%CI:0.811-0.892).When the cut-off value of TB-IGRA was 26.5 pg/ml,the sensitivity and specificity were 83.9%and 78.9%,respectively.The AUC of the five indexes was 0.902,and the sensitivity and specificity were 87.6%and 81.6%,respectively.Conclusion In patients with tuberculous pleural effusion,the expressions of TB-specific T cell(IFN-γ)and ADA,LDH,TP and ALB in pleural effusion were increased.The combined detection of peripheral blood TB-IGRA test and pleural effusion ADA,LDH,TP and ALB significantly improved the diagnostic sensitivity and specificity,which has good clinical application value in the auxiliary diagnosis of tuberculous pleural effusion.

关 键 词：结核性胸腔积液 Γ-干扰素释放试验 胸水腺苷酸脱氨酶 白蛋白 总蛋白 乳酸脱氢酶 

分 类 号：R521.7[医药卫生—内科学]