国产外周全血γ干扰素实验对肺结核病的诊断价值

Diagnostic value of domestic peripheral blood gamma interferon experiment for pulmonary tuberculosis

目的探讨国产酶联免疫吸附试验法检测结核特异性细胞免疫反应(简称A.TB检测)对肺结核病的诊断价值。方法2013年5-11月在解放军总医院海南分院就诊的疑似肺结核患者326例,均进行A.TB检测,排除资料不全和最终不能确诊病例,共318例纳入分析,其中确诊肺结核患者89例,回顾性分析A.TB对于肺结核病诊断的价值。结果在确诊为肺结核的89例患者中,涂阳28例,其中经A.TB检测阳性20例,阳性率为71.4%;涂阴61例,其中经A.TB检测阳性45例,阳性率为73.8%。对于确诊为肺结核中的涂阳患者、涂阴患者及非结核患者,A.TB的浓度呈明显降低趋势,且差异有统计学意义(χ2=97.360,P=0.001)。涂阳与涂阴患者的A.TB浓度水平均明显高于非结核患者(P=0.001)。入组患者A.TB浓度的ROC曲线下面积为0.816(P=0.001),敏感性为71.9%,特异性为86.1%;涂阳患者A.TB浓度的ROC曲线下面积为0.762(P=0.001),敏感性为71.4%,特异性为87.8%;涂阴患者A.TB浓度的ROC曲线下面积为0.841(P=0.001),敏感性为72.1%,特异性为86.5%。结论国产A.TB可以作为肺结核病的辅助诊断手段。

Objective To explore the domestic ELISA assay for detecting specific cellular immune response to tuberculosis （A.TB test） in the diagnosis of tuberculosis patients.Methods Of the 326 patients with suspected pulmonary tuberculosis who were checked with A.TB in Hainan Branch of Chinese PLA General Hospital from May 2013 to November 2013, 318 patients were involved in this trial with excluding the data incomplete and ultimately unconfirmed cases. A.TB value for pulmonary tuberculosis diagnosis in 89 patients who were diagnosed as tuberculosis was retrospectively analyzed.ResultsOf the 89 cases with pulmonary tuberculosis, 28 cases were smear-positive, including 20 cases being positive detected by A.TB test with the positive rate of 71.4%; 61 cases were smear-negative patients, including 45 cases being positive detected by A.TB test with the positive rate of 73.8%. For patients in the diagnosis of pulmonary tuberculosis with smear-positive, smear-negative and patients in the diagnosis of non tuberculosis, A.TB concentration showed a trend of decrease with significant difference between each other （χ^2=97.360,P=0.001）. The A.TB concentration average levels of smear positive and smear negative were significantly higher than that ofnon tuberculosis （P=0.001）. ROC curve area of the 89 patients with A.TB concentration was 0.816 （P=0.001） with the sensitivity of 71.9% and the specificity of 86.1%; ROC curve area of smear positive patients with A.TB concentration was 0.762 （P=0.001） with the sensitivity of 71.4% and the specificity of 87.8%; ROC curve area of smear negative patients with A.TB concentration was 0.841 （P=0.001） with the sensitivity of 72.1% and the specificity of 86.5%. Conclusion Domestic A.TB can be used as an auxiliary diagnosis method for pulmonary tuberculosis.