γ-干扰素对老年结核性胸膜炎的诊断价值

Analysis the diagnostic value of interferon-γ in elderly patients with tuberculous pleurisy

目的探讨γ-干扰素对老年结核性胸膜炎的诊断价值。方法将2012年3月至2014年5月在我院就诊的胸腔积液患者86例,分为结核组(结核性胸膜炎52例)和对照组(非结核性胸膜炎34例)。对所有患者的胸积液进行IFN-γ浓度、ADA活性以及LAM-IgG阳性率检测;分析三种诊断方案对老年结核性胸膜炎诊断的敏感性、特异性和准确性。结果结核组患者胸腔积液的IFN-γ浓度、ADA活性以及LAM-IgG阳性率均显著高于对照组,差异均具有统计学意义(P<0.05)。IFN-γ检测对老年结核性胸膜炎诊断的敏感性为86.5%,高于ADA检测,显著高于LAM-IgG阳性率检测(P<0.05);IFN-γ诊断的准确性高于其他两种诊断方法,但差异不显著(P>0.05);三种诊断方法的特异性差异不显著。IFN-γ和ADA检测的ROC曲线下面积分别0.907和0.845。三种方法联用对结核性胸膜炎诊断的敏感度为69.2%(36/52),特异性为100%(34/34)。结论 IFN-γ检测胸腔积液是一种较为准确的诊断老年结核性胸膜炎的方法,与ADA活性和LAM-IgG阳性率联合检测可提高诊断的特异性。

Objective To evaluate the diagnostic value of interferon-γ（IFN-γ）in elderly patients with tuberculous pleurisy.Methods 86 elderly patients with pleural fluid in our hospital between Mar 2012 and May 2014 were pleural tuberculosis group（52cases with tuberculous pleurisy）and control group（34cases non-pleural tuberculosis）.The level of IFN-γ,ADA activity and LAM-IgG positive rate in pleural fluid were measured,to analyze sensitivity,specificity and accuracy in the diagnosis of elderly patients with tuberculous pleurisy.Results The level of IFN-γ,ADA activity and LAM-IgG positive rate of patients in pleural tuberculosis group were significantly higher than control group（P〈0.05）.The sensitivity of IFN-γin diagnosing tuberculous pleural was 86.5%,higher than ADA,and significantly higher than LAM-IgG（P〈0.05）.The accuracy of IFN-γwas slightly higher than ADA and LAM-IgG（P〉0.05）.There was no significant difference in specificity of three methods.The area under the ROC curve was 0.907 for IFN-γand0.845 for ADA.The sensitivity of combination diagnosis of IFN-γ,ADA and LAM-IgG was 69.2%（36/52）,and the specificity increased to 100%（34/34）.Conclusion Interferon-gamma release assay is a relatively accurate diagnosis of pleural tuberculosis,and the combination of IFN-γ,ADA and LAM-IgG is of diagnostic value.