痰涂片阳性肺结核患者γ-干扰素释放试验结果一致性及影响因素分析  

Conconsistency and Influencing Factors of Sputum Smear-Positive Pulmonary Tuberculosis

作　　者：谢悦坚 容文潮 黄碧红 甄杏意 Xie Yuejian(Taishan People’s Hospital,Guangdong 529200)

机构地区：[1]台山市人民医院,广东529200

出　　处：《黑龙江医药》2023年第1期23-26,共4页Heilongjiang Medicine journal

基　　金：江门市医疗卫生领域科技计划项目(编号:2019020400300002408)。

摘　　要：目的:探究痰涂片阳性肺结核患者γ-干扰素(IFN-γ)释放试验(IGRA)结果一致性及影响因素。方法:选取2018年10月至2020年10月我院收治的198例痰涂片阳性肺结核患者为研究对象,根据IGRA检测结果分为107例IGRA阳性组和91例假阴性组。采用酶联免疫法检验IFN-γ。比较两组基础资料、实验室指标等,采用Kappa检验行一致性分析,影响因素分析采用多因素Logistic回归分析探讨。结果:198例涂阳肺结核患者中IGRA检测阳性107例,阳性率为54.04%;痰涂片镜检、IGRA、联合应用与临床诊断的一致性分别为0.587、0.653、0.828,联合应用与临床诊断一致性最高(P<0.05);IGRA阳性组和假阴性患者体质量指数(BMI)、白细胞计数(WBC)、淋巴细胞及中性粒细胞百分比、血红蛋白(Hb)、血清白蛋白(ALB)、血小板计数(PLT)、C反应蛋白(CRP)、血红细胞沉降率(ESR)、总T淋巴细胞计数、CD4^(+)、CD8^(+)T淋巴细胞计数、CD4^(+)/CD8^(+)比值比较有显著差异(P<0.05);WBC、PLT、CRP、ESR高表达[OR及95%CI:2.02(1.27~3.20)、4.79(1.72~13.33)、18.55(2.75~124.97)、1.90(1.24~2.89)]、CD4^(+)T淋巴细胞计数低表达[OR及95%CI:3.88(1.60~9.41)]为患者IGRA检测假阴性的危险因素( P <0.05)。 结论: 痰涂片镜检、IGRA联合应用与临床诊断的一致性良好,WBC、PLT、CRP、ESR升高,CD4 ^(+) T淋巴细胞计数降低是IGRA检测假阴性的危险因素。Objective:To explore the consistency and influencing factors of interferon(IFN-)release test(IGRA)results in sputum smear-positive pulmonary tuberculosis patients.Methods:198 sputum smear-positive tuberculosis patients admitted to our hospital from October 2018 to October 2020 were selected as the study subjects and divided into 107 I G R A-positive groups and 91 false-negative groups according to the IGRA test results.IFN-was tested by enzyme-linked immunoassay.To compare the basic data and laboratory indicators of the two groups,Kappa test line consistency analysis,and multivariate Logistic regression analysis were used.Results:Among 198 patients with pulmonary tuberculosis,107 had positive IGRA test,The positive rate was 54.04%;The agreement of sputum smear microscopy,IGRA,combination application and clinical diagnosis was 0.587,0.653,and 0.828,respectively,The highest agreement between the combination and the clinical diagnosis(P<0.05);For IGRA positive and false-negative patients,body mass count(WBC),lymphocyte and neutrophil percentage,hemoglobin(Hb),serum albumin(ALB),platelet count(PLT),C reactive protein(CRP),red blood cell sedimentation rate(ESR),total T lymphocyte count,CD4^(+),CD8^(+)T lymphocyte count,CD4^(+)/CD8^(+)ratio(P<0.05);WBC,PLT,CRP,ESR high expression[OR and 95%CI:2.02(1.27~3.20),4.79(1.72~13.33),18.55(2.75~124.97),1.90(1.24~2.89)],and CD4^(+)T lymphocyte count low expression[OR and 95%CI:3.88(1.60~9.41)]were risk factors for false negative IGRA detection(P<0.05).Conclusion:Good agreement of sputum smear microscopy,IGRA and clinical diagnosis,increased WBC,PLT,CRP and ESR,and decreased CD4^(+)T lymphocyte count were the risk factors for false negative IGRA test.

关 键 词：肺结核 痰涂片阳性 Γ-干扰素 一致性 

分 类 号：R521[医药卫生—内科学]