结核特异性QFT⁃TB在结核患者不同类型标本中的检测价值

The detection value of tuberculosis-specific QFT-TB in different types of specimens of tuberculosis patients

目的比较结核诊断实验室特异性细胞免疫IGRAs体外检测QuantiFERON-TB Gold(QFTTB)方法对肺结核、肺外结核和特殊人群样本的诊断效能,为临床诊疗提供依据。方法收集2023年1-7月实验室检查细菌学检测结核患者546例[痰涂片阳性(AFB+)146例,痰涂片阳性(AFB-)247例],分子生物学阳性结核患者117例(Xpert 69例,TB-DNA 48例),病理组织学阳性患者36例。肺外结核患者72例,特殊样本胸水276例,腹水25例。采用QFT-TB方法进行检测,利用χ^(2)检验进行组间比较,对比其阳性率和符合率的方法学评估。结果肺结核、肺外结核和结核密切接触者QFT-TB检测阳性率为83.69%、69.44%和32.41%。在AFB+、GeneXpert、TB-DNA和病理证实确诊为结核病患者QFT-TB方法的符合率为91.09%、88.40%、81.25%和72.22%。结核性胸膜炎患者胸水检测阳性率为60.50%、腹水阳性率为44.00%。结论QFT-TB检测在辅助诊断肺结核有较好价值,对于基于胸、腹水的检测用于肺外结核的诊断有一定的参考意义。

Objective The study aimed to compare the diagnostic efficacy of QuantiFERON⁃TB Gold(QFT⁃TB)detection of specific cellular immune IGRAs in tuberculosis diagnostic laboratory for pulmonary tuberculosis,extrapulmonary tuberculosis and special population samples in vitro,which may provide evidence for clinical diagnosis and treatment.Methods A total of 546 patients with tuberculosis(AFB+146 cases,AFB⁃247 cases),117 patients with molecular biology positive tuberculosis(Xpert 69 cases,TB⁃DNA 48 cases)and 36 patients with histopathological positive were collected from January to July 2023.There were 72 cases of extrapulmonary tuberculosis,276 cases of pleural effusion and 25 cases of ascites.QFT⁃TB method was used for detection,chi⁃square test was applied for com⁃parison between groups,and the methodological evaluation of positive rate and coincidence rate were all compared.Results The positive rates of QFT⁃TB in pulmonary tuberculosis,extrapulmonary tuberculosis and close contacts were 83.69%,69.44%,and 32.41%,respectively.The coincidence rates of QFT⁃TB in AFB+,GeneXpert,TB⁃DNA and pathological confirmed tuberculosis patients were 91.09%,88.40%,81.25%,and 72.22%,respectively.The positive rate of pleural effusion in patients with tuberculous pleurisy was 60.50%,and the uncertainty rate was 29.71%.The positive rate of ascites was 44.00%and the uncertainty was 36.00%.Conclusion QFT⁃TB test has good value in the auxiliary diagnosis of pulmonary tuberculosis,and has certain reference significance for the diagnosis of extrapulmonary tuberculosis based on the detection of pleural fluids and ascites.