γ干扰素释放实验的临床应用研究

Clinical application of interferon-γ release assay

目的探讨γ干扰素释放实验(interferon-γrelease assay,IGRA)在结核病诊断中的应用价值,有助于提高结核检出率。方法 348例结核病和非结核病患者常规进行痰涂片、结核菌素皮试(TST)及IGRA检测,以临床明确诊断为准,比较分析评价IGRA的临床应用价值。结果用于结核感染的诊断,IGRA检测的敏感性优于TST,分别为71.0%和51.3%;IGRA检测的特异性也优于TST,分别为81.2%和66.9%;用于结核性胸膜炎的诊断,IGRA检测的敏感性优于TST,分别为72.9%和35.6%,特异性也优于TST,分别为84.6%和61.5%;用于肺外结核的诊断,IGRA检测的敏感性优于TST,分别为68.0%和36.0%,特异性也优于TST,分别为85.7%和57.1%,以上差异均有统计学意义(P<0.05);此外,对于涂阴结核患者,IGRA检出率明显高于TST,分别为66.7%和43.4%,P<0.05,IGRA阳性还可能与抗结核治疗转归相关。结论 IGRA有助于提高结核检出率,可作为临床鉴别结核感染尤其是菌阴结核、肺外结核的重要辅助诊断方法,具有一定的临床推广价值。

OBJECTIVE To explore the clinical value of interferon-γ release assay （IGRA） in the diagnosis of tuberculosis so as to raise the diagnostic rate of tuberculosis. METHODS Totally 348 cases of TB patients and non TB patients were divided based on the clinical diagnosis, all patients were conducted sputum smear and tuberculin skin test （TST） and IGRA testing conventionally. The clinical values of IGRA were concluded. RESULTS For the diagnosis of tuberculosis, the IGRA had the higher sensitivity （71.0% and 51.3%） and specificity（81.2% and 66.9%） when compared with TST; for the diagnosis of tuberculous pleurisy, the IGRA had the higher sensitivity （72.9% and 35.6%） and specificity（84. 6% and 61.5%） when compared with TST; for the diagnosis of non- pulmonary tuberculosis, the IGRA had the higher sensitivity（68.0% and 36. 0%） and specificity （85. 7% and 57.1%） when compared with TST, all the P value were less than 0.05. What＇s more, the IGRA had a higher pos- itive rate than did TST for smear-negative TB patients （66.7% and 43.4% ,P〈0.05）. The responses of IGRA may indicated the effect of anti-tuberculosis treatment. CONCLUSION IGRA can raise the detection rate of tuberculosis. It could be used as an important auxiliary diagnostic method for the diagnosis of tuberculosis, especially in the patients with tuberculous pleurisy or non-pulmonary tuberculosis.