肺结核发病后不同时间检测TB-IgG的诊断价值探讨

Investigate the Diagnostic Value of Detecting Serum TB-IgG in Different Time in Patients with Pulmonary Tuberculosis

目的探讨肺结核发病不同时间检测血清结核分枝杆菌抗体(TB-IgG)在肺结核诊断中的价值。方法收集肺部疾病患者为2008年2月至2010年6月本院住院患者共145例。采用斑点免疫渗滤试验法检测结核病住院患者106例和非结核呼吸系统疾病患者39例血清中TB-IgG,同时做痰涂片抗酸染色镜检以及影像学检测;以66例初治结核患者为对象,分析起病后2周内、2～4周、4周后血清中TB-IgG阳性率的差异。结果结核患者TB-IgG、痰涂片、影像学阳性率显著高于非结核患者(P<0.05),这三种检测方法分别与临床综合诊断一致性检验的Kappa值分别为痰涂片(0.261)、影像学(0.506)、TB-IgG(0.267);痰涂片、TB-IgG在起病后2周内、或者起病2周以上的检测阳性率明显低于起病2～4周;并且,TB-IgG、痰涂片在3个不同时间段阳性率差异显著(P<0.05)。结论要提高TB-IgG在结核诊断中的临床价值,应选择在患者起病2～4周之间进行检测或者复测,能减少漏诊率。

Objective To investigate the diagnostic value of detecting serum TB-IgG at different times in patients with pulmonary tuberculosis. Methods 145 inpatients in our hospital from February 2008 to June 2010 were selected in this study, including 106 inpatients with pulmonary tuberculosis and 39 patients with other respiratory system diseases （non pulmonary tuberculosis） All patients received detection of TB-IgG in serum by method of dot immunogold filtration assay; the acid-fast stain test of sputum smear microscopic examination and imaging detection were taken in the meantime. 66 naive pulmonary tuberculosis patients were selected to analyze the difference of serum TB-IgG positive rate with 2 weeks of onset, 2 to 4 weeks, and 4 week a^er onset. Results The positive rate of sputum smear, TB-IgG and imaging detection in patients with tuberculosis were significantly higher than those in patients without tuberculosis （P 〈0.05）; the detection positive rates of sputum smear, TB-IgG within two weeks or more than 4 weeks were significantly lower than those in the onset of 2 to 4 week, and the detection positive rates of TB-IgG, sputum smear were significantly different at three different periods （P 〈0.05）. Conclusions To improve the TB-IgG clinical value of the diagnosis of tuberculosis, we will detect or retest at the onset of 2 to 4 weeks to reduce the misdiagnostic rate.