γ-干扰素释放试验在肺结核与非结核分枝杆菌肺病诊断的价值

Performance of the γ-interferon release assay in diagnosing tuberculosis and nontuberculous mycobacteria

目的评估γ-干扰素释放试验（IGRAs）在诊断肺结核（pulmonary tuberculosis，PTB）与非结核分枝杆菌（nontuberculous mycobacteria，NTM）肺病中的价值。方法收集2013年3月至2014年6月期间广州市胸科医院住院患者214例，共分3组：PTB组87例，NTM肺病组70例和其他肺部疾病组57例。应用结核感染T细胞斑点试验（T-SPOT．TB）试剂盒进行γ-干扰素释放试验，检测各组外周血淋巴细胞对结核分枝杆菌菌种特异性分泌蛋白：早期分泌靶抗原6（ESAT-6）和培养分泌蛋白10（CFP-10）的免疫反应情况。结果T-SPOT,TB结果显示87例肺结核患者77例阳性（阳性率88．51％），70例NTM肺病患者16例阳性（阳性率22．86％），57例其他肺部疾病患者13例阳性（阳性率为22．81％），PTB组T-SPOT.TB阳性率明显高于NTM肺病组（X^2=69．23，P〈0．01）和其他肺部疾病组（X2=63．42，P〈0．01），差异均有统计学意义，而NTM肺病组和其他肺部疾病组阳性率比较差异无统计学意义（X^2=0．00，P=1．00）。结论T-SPOT.TB可快速辅助诊断肺结核和NTM肺病。

Objective To evaluate the value of interferon-gamma release assays （IGRAs） for diagnosing pulmonary tuberculosis （PTB） and nontuberculous mycobacteria （NTM）. Methods A total of 214 in-patients were enrolled in this study between March 2013 and June 2014. The patients were divided into three groups： 87 PTB cases, 70 NTM cases and 57 cases with other lung diseases. T-SPOT. TB was used to detect the immune response of peripheral blood lymphocytes against tuberculosis-specific secretory proteins ESAT-6 and CFP-10. Results T-SPOT. TB tests were positive in 77 （88.51%） of the 87 TB cases, 16 （22.86%） of the 70 NTM cases, and 13 （22.81%） of the 57 cases with other lung diseases. The positive detection rate for the TB group was significantly higher than that for the NTM group （X2 = 69.23,P〈0.01） and other lung disease group （X2 = 63.42, P〈0. 01）. However, there was no significant difference in the positive detection rate between the NTM and other lung disease groups （X^2= 0. 00, P=1.00）. Conclusion T-SPOT. TB can be used as an alternative auxiliary diagnostic method for distinguishing PTB and NTM patients.