γ-干扰素释放试验在诊断原发女性不孕患者潜伏性结核感染中的应用

Application of interferon-gamma release assay on the diagnosis of latent tuberculosis infection in female primary infertility patients

目的研究γ-干扰素释放试验在诊断原发女性不孕患者潜伏性结核感染中的临床应用价值。方法前瞻性收集2013年1月至2015年3月我院收治的原发性女性不孕患者100例,根据两组患者结核菌素皮肤试验(TST)水平,将患者分为TST阳性组(n=64)和TST阴性(n=36)组。使用A.TB试剂盒,采用酶联免疫法(ELISA)进行γ-干扰素释放试验定量检测外周血γ-干扰素含量。比较两组患者治疗前及TST阳性组抗结核治疗后血γ-干扰素水平。结果两组患者的年龄和月经周期异常、月经量异常、白带异常、外阴瘙痒、子宫内膜形态异常率及生殖系统感染史、卡介苗接种史等差异均无统计学意义(P均>0.05)。与TST阴性组相比,TST阳性组患者血γ-干扰素水平显著增高[(8.63±3.22)IU/ml vs(3.96±1.19)IU/ml,P<0.01]。对TST阳性组64例患者给予异烟肼联合利福平治疗3个月后,其中59.38%(38例)转为阴性,根据患者TST结果分为TST阴转亚组(n=38)和TST持续阳性亚组(n=26)。TST持续阳性亚组患者血γ-干扰素水平治疗后较治疗前[(4.38±1.55)IU/ml vs(8.63±3.22)IU/ml]明显降低(P<0.01),但TST阴转亚组和TST持续阳性亚组治疗后组间比较无统计学差异[(4.30±1.09)IU/ml vs(4.38±1.55)IU/ml,P>0.05]。TST阴转亚组患者中,3例治疗后6个月成功怀孕。结论γ-干扰素释放试验在诊断原发女性不孕患者潜伏性结核感染中具有重要的临床价值。

Objective To investigate clinical application value of interferon-gamma release assay in the diagnosis of latent tuberculosis infection in female primary infertility patients. Method The clinical data of 100 female primary infertility patients received and cured between January 2013 and March 2015 were collected prospectively. According to tuberculin skin test （TST） result ,the patients were divided into positive TST group （n = 64 ） and negative TST group （n =36 ）. Using A. TB kit,enzyme linked immunosorbent assay （ELISA） was used to perform interferon-gamma release assay. Blood interferon-gamma （γ-IFN） levels before therapy in two groups and the change of blood γ-IFN levels after therapy in positive TST group were compared. Result There were no significant difference in age ,incidences of abnormality of menstrual cycle, abnormality of menstrual blood volume, abnormality of leucorrhea, pruritus vulvae, abnormality of endometrial shape and the history of the reproductive system infection, history of bacille ealmette-guerin vaccination between two groups （ all P 〉 0. 05 ）. The γ-IFN level in positive TST group significantly increased compared with that in negative TST group [ （ 8.63 ±3.22） IU/ml vs （3.96 ± 1.19） IU/ml, P 〈 0.01 ]. Three months after treatment of isoniazid and rifampicin in positive TST group,the patients were re-divided into TST converted to negative subgroup （n = 38）and TST persistent positive subgroup （ n = 26） according to the result of rechecking TST. Compared with before therapy, the γ-IFN levels in both TST converted to negative subgroup and TST persistent positive subgroup after therapy significantly decreased, but showed no significant difference between two subgroups after therapy[ （4.30±1.09 ） IU/ml vs （4.38 ±1.55 ） IU/ml,P 〉 0.05 ]. In TST converted to negative subgroup, three patients got pregnant successfully six months after treatment. Conclusion Interferongamma release assay has an important clinical value for diagnosis of latent tuberculosis infection in female primary infertility patients.