全血γ干扰素释放试验诊断结核性胸腔积液的评估

Assessment of the whole blood interferonγrelease assay in diagnosis of tuberculous pleural effusion

目的 评价全血IFNγ释放试验对结核性胸腔积液诊断的应用价值。方法应用全血中可溶性IFNγ的酶联免疫吸附（QFT-GIT）试验对60例胸腔积液患者进行检测。包括结核性胸腔积液患者44例和非结核性胸腔积液患者16例。检测受测者外周血淋巴细胞受结核分枝杆菌特异性抗原刺激后所释放的IFN_7，所使用的结核分枝杆菌抗原为6×10^3早期分泌靶抗原蛋白（EsAT-6）、培养滤液蛋白10（CFP_10）和TB7．7。两组IFNγ释放量比较采用非参数Mann-whitmey检验。结果结核性胸腔积液组QFT-GIT试验阳性率为95．5％，非结核性胸腔积液组阳性率为12．5％。QFT-GIT试验诊断结核性胸腔积液的敏感度为95．6％，特异度为87．5％，阳性预测值为95．6％，阴性预测值为87．5％。结核性胸腔积液组抗原特异性T淋巴细胞应答明显高于非结核性胸腔积液组患者（P〈0．01）。结论QFT-GIT试验用于诊断结核性胸腔积液具有较高的敏感度和特异度，在我国具有较高的临床应用价值。

evaluate the application of a whole Blood interferonγ （IFN-7） release assay QuantiFERON-TB Gold In Tube （QFT-GIT） in the diagnosis of tuberculous pleural effusion. Methods IFNγ released by specific T cells stimulated by early secreted antigenic target 6 5〈 103 protein （ESAT-6）, culture filtrate protein 10 （CFP-10） and TB7.7 were measured by QFT-GIT test in 44 tuberculous pleural effusion patients and 16 non tuberculous pleurisy controls. The IFNγ release level between groups was compared by Mann-Whitmey test. Results The positive rates of QFT-GIT in patients with tuberculous pleural effusion and non-tuberculous pleurisy were 95.5 % and 12.5 %, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of QFT GIT were 95.6%, 87.5%, 95.6% and 87.5%, respectively. The antigen-specific IFN-）＂ release level in the patients with tuberculous pleural effusion was significantly higher than that in non tuberculous pleurisy controls （P〈0.01）. Conclusions The whole blood INF-7 release assay QFT- GIT is a sensitive and specific assay for detecting pleural tuberculosis infection. It could be a useful diagnostic tool for the diagnosis of tuberculous pleural effusion in China.