IFN-γ和IL-2联合检测对老年人群肺结核辅助诊断及与肺炎患者鉴别诊断的价值  

Value of IFN-γ and IL-2 Combined Detection in the Auxiliary Diagnosis of Pulmonary Tuberculosis in the Elderly Population and the Differential Diagnosis of Pneumonia

作　　者：张鑫 杨增伟 孙建军 徐芳 魏黛珏 李东辉 曹文静 同重湘 ZHANG Xin;YANG Zengwei;SUN Jianjun;XU Fang;WEI Daijue;LI Donghui;CAO Wenjing;TONG Chongxiang(Clinical Laboratory,Lanzhou Pulmonary Hospital(Gansu Provincial Infectious Disease Hospital),Lanzhou,Gansu 730030,China)

机构地区：[1]兰州市肺科医院(甘肃省传染病医院)检验科,甘肃兰州730030

出　　处：《临床肺科杂志》2025年第3期412-416,共5页Journal of Clinical Pulmonary Medicine

基　　金：2023年度国家重点研发专项(2023YFC2307200-2023YFC2307201);兰州市科技发展指导性计划项目(2024-9-212);兰州市科技发展计划项目(2021-1-119)。

摘　　要：目的评价结核分枝杆菌特异性IFN-γ和IL-2(双因子)联合检测在老年肺结核辅助诊断及与老年肺炎患者鉴别诊断的效果。方法回顾性分析2024年1月至6月兰州市肺科医院年龄≥60周岁疑似肺结核的住院患者226例,其中老年肺结核患者174例(PTB组)、老年肺炎患者52例(CAP组),PTB组根据病原学结果分为菌阴肺结核组(79例)和菌阳肺结核组(95例)。所有患者均行双因子联合检测、病原学检测、炎性指标CRP和PCT检测,比较分析双因子联合检测在老年人群中菌阳肺结核、菌阴肺结核以及肺炎患者的诊断效果。结果PTB组IFN-γ、IL-2的中位数分别为31.2(10.7,267.0)pg/mL、48.1(20.7,176.8)pg/mL,与CAP组IFN-γ、IL-2的中位数1.9(0.0,4.2)pg/mL、2.4(0.2,9.5)pg/mL有显著差异(P<0.05);PTB组炎症指标CRP、PCT与CAP组CRP、PCT相比无显著差异(P>0.05);双因子联合检测的灵敏度为85.1%、特异度为84.6%,单检IFN-γ的灵敏度为78.7%、特异度为88.5%,单检IL-2的灵敏度为77.0%、特异度92.3%,IL-2的引入相较于单检IFN-γ灵敏度提高6.4%;双因子联合检测灵敏度显著高于病原学(54.6%)检测(P<0.05);双阳结果在PTB组中占比70.7%,双阳结果特异度为96.2%;在老年肺结核患者中菌阴、菌阳肺结核的双因子联合检测灵敏度无显著差异(P>0.05);双因子联合检测的AUC值为0.881(95%CI:0.837~0.925),CRP、PCT检测的AUC值分别为0.555(95%CI:0.466~0.643)、0.553(95%CI:0.465~0.640),双因子联合检测在老年人群结核病诊断效果显著高于CRP、PCT(P<0.05)。结论结核分枝杆菌特异性IFN-γ和IL-2联合检测在老年肺结核患者中具有较好的辅助诊断价值,特别是在老年菌阴肺结核中,有助于提高老年肺结核诊断的准确率,除此之外,IFN-γ和IL-2双阳结果对老年肺结核与肺炎患者鉴别诊断具有较高价值。Objective To evaluate the effect of Mycobacterium tuberculosis-specific IFN-γ and IL-2(two-factor)combined detection in the auxiliary diagnosis of pulmonary tuberculosis and differential diagnosis with pneumonia in elderly patients.Methods A retrospective analysis was performed on 226 hospitalized patients with suspected pulmonary tuberculosis aged≥60 years in Lanzhou Pulmonary Hospital from January to June 2024,including 174 elderly patients with pulmonary tuberculosis(PTB group)and 52 elderly patients with pneumonia(CAP group).The PTB group was divided into the bacteriopositive pulmonary tuberculosis group(79 cases)and the bacteriopositive pulmonary tuberculosis group(95 cases)according to the etiological results.All patients were tested with two-factor combined detection,etiology detection,inflammatory index CRP,and PCT detection,and the diagnostic effect of two-factor combined detection in the elderly patients with positive pulmonary tuberculosis,negative pulmonary tuberculosis,and pneumonia were compared and analyzed.Results The median values of IFN-γ and IL-2 in PTB group were 31.2(10.7,267.0)pg/mL and 48.1(20.7,176.8)pg/mL,respectively,which were significantly different from those in CAP group 1.9(0.0,4.2)pg/mL and 2.4(0.2,9.5)pg/mL(P<0.05).The median values of CRP and PCT in PTB group which were not significantly different from those in the CAP group(P>0.05).The sensitivity and specificity of two-factor combined assay were 85.1% and 84.6%,the sensitivity and specificity of IFN-γ single assay were 78.7% and 88.5%,and the sensitivity and specificity of IL-2 single assay were 77.0% and 92.3%,respectively.The introduction of IL-2 was 6.4% higher than that of IFN-γ single assay.The sensitivity of two-factor combined detection was significantly higher than that of etiology detection(54.6%)(P<0.05).IFN-γ and IL-2 positive results accounted for 70.7% in the PTB group,and the specificity of IFN-γ and IL-2 positive results was 96.2%.There was no significant difference in the sensitivity of two-factor combin

关 键 词：老年 肺结核 肺炎 IFN-γ和IL-2联合检测 炎症指标 

分 类 号：R563.1[医药卫生—呼吸系统] R521[医药卫生—内科学]