γ-干扰素释放试验在结核病筛查中的辅助诊断价值  

Auxiliary diagnostic value ofγ-interferon release assay in tuberculosis screening

作　　者：江丽娜[1] 陈盛玉 孟苏凯[1] 孙蕊[1] 吴振萍[1] 王秀月 张玉华[1] 王春花[1] JIANG Lina;CHEN Shengyu;MENG Sukai;SUN Rui;WU Zhenping;WANG Xiuyue;ZHANG Yuhua;WANG Chunhua(Tianjin Center for Tuberculosis Control,Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease,Tianjin 300011,China)

机构地区：[1]天津市结核病控制中心,天津市传染病病原微生物重点实验室,天津300011

出　　处：《中国热带医学》2024年第2期171-175,共5页China Tropical Medicine

基　　金：天津市卫生健康科技项目(No.TJWJ2022MS047)。

摘　　要：目的分析比较γ-干扰素释放试验(interferon-gamma releaseassay,IGRA)对结核病诊断的辅助价值和意义。方法采用回顾性分析的方法收集2020年1月—2021年12月在天津市结核病控制中心门诊部进行IGRA检测的462例疑似结核病患者的检测结果,根据诊断结果分为结核病组229例(肺结核组203例和肺外结核组26例),非结核病组233例。分析IGRA对结核病的辅助诊断价值,并将其与结核分枝杆菌培养、结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术(geneXpert Mycobacterium tuberculosis/rifampin,Xpert MTB/RIF)2种方法进行比较。结果IGRA、结核分枝杆菌培养和Xpert MTB/RIF在结核病患者中的阳性率分别为76.42%、29.26%、40.62%,与非结核病组比较(38.20%、0.00%、0.00%),差异有统计学意义(P<0.001)。IGRA单独检测结核病的灵敏度、特异度、阳性预测值和阴性预测值分别为76.42%、61.80%、69.29%、72.73%,结核分枝杆菌培养检测结核病的灵敏度、特异度、阳性预测值和阴性预测值分别为29.26%、98.28%、94.37%、63.43%,Xpert MTB/RIF检测结核病的灵敏度、特异度、阳性预测值和阴性预测值分别为40.60%、100%、100%、63.14%。IGRA在肺结核和肺外结核患者中阳性率分别为76.85%、73.08%,差异无统计学意义(P>0.05)。在菌阳患者组、非结核患者组中IGRA检测结核的阳性率分别为79.34%、38.20%,差异有统计学意义(χ^(2)=54.526,P<0.001);在菌阴患者组、非结核患者组中IGRA检测结核的阳性率分别为73.15%、38.20%,差异有统计学意义(χ^(2)=36.456,P<0.001)。结论IGRA在结核病患者的诊断中具有较高的灵敏度,在肺外结核和菌阴结核的筛查也有一定的优势,为临床上诊断结核病提供重要的参考依据。Objective To analyze and compare the auxiliary value and significance ofγ-interferon release assay(IGRA)in the diagnosis of tuberculosis.Methods A retrospective analysis was conducted to collect the test results of 462 suspected tuberculosis patients who underwent IGRA detection in the outpatient department of Tianjin Tuberculosis Control Center from January 2020 to December 2021.According to the diagnostic results,they were divided into a tuberculosis group of 229 cases(203 cases of pulmonary tuberculosis and 26 cases of extrapulmonary tuberculosis)and a non-tuberculosis group of 233 cases.The auxiliary diagnostic value of IGRA for tuberculosis was analyzed and compared with two methods of Mycobacterium tuberculosis culture and Xpert MTB/RIF.Results The positive rates of IGRA,Mycobacterium tuberculosis culture,and Xpert MTB/RIF in TB patients were 76.42%,29.26%and 40.62%,respectively,compared with the non-TB group(38.20%,0.00%,0.00%),with statistically significant differences(P<0.001).The sensitivity,specificity,positive predictive value,and negative predictive value of IGRA alone in the detection of tuberculosis were 76.42%,61.80%,69.29%,and 72.73%respectively,those of Mycobacterium tuberculosis culture were 29.26%,98.28%,94.37%,and 63.43%,and those of Xpert MTB/RIF were 40.60%,100%,100%,and 63.14%.The positive rates of IGRA were 76.85%and 73.08%in patients with pulmonary tuberculosis and extrapulmonary tuberculosis,respectively,with no statistical significance(P>0.05).The positive rates of IGRA in bacterial positive patients and non-tuberculosis patients were 79.34%and 38.20%,respectively,with statistical significance(χ^(2)=54.526,P<0.001).The positive rates of IGRA in patients with and without tuberculosis were 73.15%and 38.20%,respectively,with significant difference(χ^(2)=36.456,P<0.001).Conclusions IGRA has a relatively high sensitivity in the diagnosis of tuberculosis and also has certain advantages in the screening of extrapulmonary tuberculosis and mycobacterium-negative It provides important referen

关 键 词：Γ-干扰素释放试验 结核分枝杆菌培养 实时荧光定量核酸扩增检测 结核病 

分 类 号：R52[医药卫生—内科学]