全血γ-干扰素释放试验在继发性肺结核中的辅助诊断价值

Auxiliary diagnostic value of the whole blood gamma release assay in vitro for secondary pulmonary tuberculosis

目的研究分析全血γ干扰素释放试验（thewholebloodinterferongammareleaseassayinvitro，IGRA-ELISA）在继发性肺结核中的辅助诊断及临床应用价值。方法前瞻性纳入2012年8月至2013年6月淮安市第四人民医院143例疑似活动性肺结核患者，包括110例活动性肺结核患者，其中继发性肺结核66例，和33例非结核病患者进行IGRA-ELISA、结核抗体、抗酸染色和结核分枝杆菌培养检测。采用SPSS18．0统计学软件进行统计分析，计数资料采用卡方检验，P〈0．05为差异有统计学意义。结果在继发性肺结核中，IGRA-ELISA敏感度为90．9％（60／66），均高于结核抗体检测（57．6％，38／66）、抗酸染色检测（16．7％，11／66），且IGRAELISA与另两种方法敏感度比较差异有统计学意义（χ^2=1．588，p=0．000；χ^2=1．320，P=0．000；χ^2=6．005，P=0．000）。特异度方面3种检测方法均在90％以上，分别为93．9％（31／33），93．9％（31／33），90．9％（30／33），IGRAELISA、结核抗体与抗酸染色检测方法特异度两两比较，差异无统计学意义（χ^2=7．220，P=1．000；χ^2=4．311，P=1．000；χ^2=0．213，p=1．000）。细菌培养阳性的继发性肺结核患者中，IGRA-ELISA阳性率为96．0％（24／25），而培阴的继发性肺结核患者中IGRA-ELISA阳性率为87．8％（36／41）。结论相比其他检测方法，IGRA-ELISA在继发性肺结核诊断中的敏感度和特异度最高，可作为继发性肺结核辅助诊断的有效依据，尤其是培阴继发性肺结核患者的辅助诊断。

Objective To evaluate the auxiliary diagnostic value of the whole blood interferon gamma release assay in vitro （IGRA-ELISA） in the patients with secondary pulmonary tuberculosis （TB）. Methods One hundred and forty three cases of suspected patients with active pulmonary TB, from August in 2012 to June in 2013 in Huai＇an No. 4 People＇s Hospital, were divided into groups and examined with IGRA ELISA test, anti-TB antibody test, sputum smear and mycobacterial culture. There were 110 cases with active pulmonary TB （including 66 cases with secondary pulmonary TB）, and 33 cases with nonTB disease-. SPSS 18.0 was used for statistical analysis, the chi square test was used for counting data, and P〈0.05 was statistically significant. Results of the patients with secondary pulmonary TB, the sensitivity of the IGRA EI.ISA test （90.9%, 60/66） was the highest of among the three tests, the sensitivities of anti-TB antibody test and sputum smear were 57.6% （38/66） and 16.7% （11/66）, respectively. They were dramatically different （χ^2= 1. 588, P= 0. 000; ）χ^2= 1. 320, P= 0. 000, χ^2= 6. 005, P= 0. 000）. The specificities of all the three tests were over 90% （93.9%, 31/33; 93.9%, 31/33; 90.9%, 30/33）, and there were no great difference （χ^2=7. 220,P-1. 000; χ^2=4. 311,P=1. 000,χ^2=0. 213,P=1. 000）. The posi- tive rates of IGRA-ELISA in culture-positive and culture-negative patients with the secondary pulmonary TB were 96.0% （24/25） and 87.8% （36/41）, respectively. Conclusion Compared with other methods, the IGRA-ELISA test enioyed the highest sensitivity and specificity in clinical application. It could be used as an auxiliary diagnostic method for the secondary pulmonary TB, especially in culture-negative pulmonary TB.