γ干扰素释放实验在早期膝关节结核临床诊断中的应用价值

The application value of interferon-γ release assay(IGRA) in the early diagnosis of knee tuberculosis

目的:探讨γ干扰素释放实验(IGRA)在早期膝关节结核诊断中的应用价值。方法:随机抽取123例非结核患者,和已经穿刺活检明确诊断,但是X线未有明显病理改变的149例早期膝关节结核患者,以及明确诊断并伴有X线明显病理改变的138例中晚期患者(所有患者半年内均无新发肺结核),进行IGRA实验以及PPD实验,比较两种方法的特异性和敏感度。比较IGRA实验阳性的早期患者和阴性早期患者的疾病相关因素,寻找IGRA实验漏诊的原因。结果:非结核患者实验结果显示,IGRA实验特异性为95.1%,而临床上常规使用的PPD实验特异性仅为64.2%,差异具有统计学意义(P<0.05);对于早期膝关节结核的患者,IGRA实验敏感度为83.2%,PPD实验敏感度为67.8%,差异具有统计学意义(P<0.05);而对于中晚期患者,IGRA实验敏感度为100%,PPD实验敏感度上升为83.3%,差异具有统计学意义(P<0.05);IGRA阳性患者血沉(ESR)为(38±4.11)mm/h,阴性患者为(14±3.72)mm/h,差异具有统计学意义(P<0.05)。结论:IGRA实验对于膝关节结核诊断的敏感度明显高于PPD实验。诊断早期膝关节结核时,如果患者的血沉速度大于20 mm/h,并且IGRA实验阳性,则患者患有膝关节结核的可能性较大,临床医师可以进行穿刺活检以明确诊断。IGRA实验对于早期膝关节结核的临床诊断有重要的辅助意义,有较大的推广价值。

Objective:To investigate the application value of interferon-γrelease assay(IGRA)in the early diagnosis of knee tuberculosis.Methods:Randomly selected 123 cases of non-tuberculosis patients,149 cases of early stage knee tuberculosis patients who had been diagnosed by biopsy but had no obvious pathological changes of X-ray report,and 138 cases of late stage patients with obvious pathological changes of X-ray report.All people took IGRA and PPD examination to compare the specificity and sensitivity of the two methods.Compareknee tuberculosis related factors of IGRA positive patients and negative patients in early stage to find the causes of misdiagnosis in IGRA assay.Results:In non-tuberculosis patients,the specificity of IGRA assay was 95.1%and PPD assay was 64.2%with a statistical difference(P<0.05).In early knee tuberculosis patients,the sensitivity of IGRA was 83.2%and PPD was 67.8%with a statistical difference(P<0.05).In late stage patients,the sensitivity of IGRA was 100%and PPD was 83.3%with a statistical difference(P<0.05).ESR of IGRA positive patients in early stage was(38±4.11)mm/h and negative patients was(14±3.72)mm/h with a statistical difference(P<0.05).Conclusion:Sensitivity of IGRA assay in early diagnosis of knee tuberculosis was significantly higher than PPD assay.If ESR of knee tuberculosis patients in early stage was greater than 20 mm/h and IGRA assay was positive,it was more likely to suffer from knee tuberculosis,and then clinicians could perform biopsy for definitive diagnosis.So IGRA assay had important value for early diagnosis of knee tuberculosis and a further expand was need.