γ-干扰素释放试验在结核病专科门诊诊断儿童活动性结核病的效能  

Evaluation of interferon-gamma release assay for the diagnosis of children with active tuberculosis in a tuberculosis specialist clinic

作　　者：马婷婷 岳英 严文 漆沄 杨翰 马进宝 MA Ting-ting;YUE Ying;YAN Wen;QI Yun;YANG Han;MA Jin-bao(Department of Gynecology and Pediatric Tuberculosis,Xi′an Chest Hospital,Xi′an,Shaanxi 710100,China;Department of Clinical Laboratory,Xi′an Chest Hospital,Xi′an,Shaanxi 710100,China;Department of Drug-resistance tuberculosis,Xi′an Chest Hospital,Xi′an,Shaanxi 710100,China)

机构地区：[1]西安市胸科医院妇儿结核科,陕西西安710100 [2]西安市胸科医院检验科,陕西西安710100 [3]西安市胸科医院耐药结核科,陕西西安710100

出　　处：《临床肺科杂志》2023年第6期848-853,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的评价γ-干扰素释放试验(interferon-gamma release assay,IGRA)在结核病专科门诊诊断儿童活动性结核病的效能。方法回顾性分析2019年1月至2021年12月就诊于西安市胸科医院结核病门诊的268例疑似结核病患儿为研究对象,采用area under the ROC curve(AUC)评估在不同年龄阶段,有无卡痕,有无结核病密切接触史患儿中IGRA诊断活动性结核病的效能。结果在结核病专科门诊,IGRA诊断儿童活动性结核的敏感度、特异度、阴性预测值、阳性预测值、AUC分别为80.6%、63.6%、48.6%、88.5%、0.74。IGRA诊断儿童结核病AUC(95%CI值),在年龄≤5岁患儿中为0.71(0.62~0.80),低于6~14岁组的0.75(0.70~0.81),两组差异无统计学意义(Z=-0.848,P=0.40);在可见卡痕患儿中为0.72(0.67~0.78),与未见卡痕组的0.72(0.61~0.83)无统计学差异(Z=0.067,P=0.946);在有密接史组为0.83(0.75~0.91),高于无密接史组的0.72(0.66~0.77),两组差异有统计学意义(Z=2.336,P=0.020)。IGRA联合TST诊断儿童结核病AUC(95%CI值)为0.79(0.74~0.83),与TST单独诊断结核病AUC无统计学差异(Z=1.598,P=0.110)。结论在结核病专科门诊γ-干扰素释放试验诊断儿童活动性结核病准确度一般,在无结核病接触史患儿中其准确度较低,结核病专科门诊使用IGRA诊断儿童活动性结核病时需考虑其密切接触史情况。Objective To evaluate the accuracy of interferon-gamma release assay(IGRA)in the diagnosis of children with active tuberculosis in a tuberculosis special hospital.Methods 268 cases with suspected tuberculosis children in Xi′an Chest Hospital from Jan 2019 to Dec 2021 were retrospectively analyzed,and the accuracy of IGRA for the diagnosis of active tuberculosis in children was evaluated using the area under the ROC curve(AUC).Results The sensitivity,specificity,negative predictive value,positive predictive value,and AUC for IGRA to diagnose active tuberculosis in children were 80.6%,63.6%,48.6%,88.5%,and 0.74 respectively.The AUC(95%CI)for IGRA to diagnose tuberculosis was 0.71(0.62~0.80)in children aged≤5 years,which was lower than 0.75(0.70~0.81)in the group aged 6~14 years,the difference between the two groups was not statistically significant(Z=-0.848,P=0.40).The AUC(95%CI)was 0.72(0.67~0.78)in the children with BCG scar,which had no difference from 0.72(0.61~0.83)children without scar(Z=0.067,P=0.946).The AUC(95%CI)was 0.83(0.75~0.91)in children with documented exposure to active tuberculosis,which was higher than 0.72(0.66~0.77)in children without exposure history.The difference between the two groups was statistically significant(Z=2.336,P=0.020).The AUC(95%CI)for IGRA combined with TST to diagnose tuberculosis was 0.79(0.74~0.83),and there was no significant difference with TST alone(Z=1.598,P=0.110).Conclusion The accuracy of the IGRA in the diagnosis of active TB in children is general in the TB specialist clinic,but low in the children without a TB contact history.The close contact history should be taken into account in the diagnosis of active TB in children in the TB specialist clinic.

关 键 词：Γ-干扰素释放试验 儿童 结核病 评价研究 

分 类 号：R529.9[医药卫生—内科学]