IGRAs在支气管扩张患者中非结核分枝杆菌肺病与肺结核鉴别诊断的价值

Value of IGRAs in differential diagnosis of nontuberculous mycobacteria pulmonary disease and pulmonary tuberculosis in patients with bronchiectasis

目的：探讨γ-干扰素释放实验（interferon gamma releasing assay,IGRAs）在支气管扩张合并非结核分枝杆菌（nontuberculosis mycobacteria,NTM）肺病和支气管扩张合并肺结核（tuberculosis,TB）鉴别诊断中的价值。方法：收集广州市胸科医院2014年1-12月根据细菌学诊断的支气管扩张分枝杆菌阳性患者436例,其中支气管扩张合并非结核分枝杆菌肺病患者150例,行IGRAs检测64例;支气管扩张合并肺结核患者284例,行IGRAs检测71例,对两种疾病的IGRAs检测结果进行回顾性分析。结果：IGRAs检测在支扩并NTM肺病和支扩并肺TB鉴别诊断中的敏感度（Se）95.77%（68/71,95%CI为93.3%~97.3%）,特异度（Sp）92.19%（59/64,95%CI为87.4%~95.2%）。IGRAs检测的阳性预测值（PPV）和阳性似然比（＋LR）分别为93.15%（68/73,95%CI为89.3%~95.7%）和12.259（95%CI为5.276~28.483）;阴性预测值（NPV）和阴性似然比（-LR）分别为95.16%（59/62,95%CI为92.1%~97.1%）和0.0458（95%CI为0.0151~0.139）。NTM组和TB组IGRAs检测定性比较（χ2=101.357,P=0.000）;定量比较ESAT-6（A孔）斑点数（t=-8.104,P=0.000）;CFP-10（B孔）斑点数（t=-11.193,P=0.000）,差异有统计学意义（P均〈0.05）。结论：支气管扩张合并分枝杆菌肺病的患者,行IGRAs检测能早期、快速、无创、准确地判断为非结核分枝杆菌肺病或是肺结核,对临床诊断和治疗有指导意义。

Objective： To investigate the value of γ-interferon gamma releasing assays（ γ-IGRAs） in the differential diagnosis of bronchiectasis complicated with nontuberculous mycobacteria（ NTM） pulmonary disease and bronchiectasis complicated with pulmonary tuberculosis（ TB）. Methods： A total of 436 cases with bronchiectasis-positive mycobacteria diagnosed by bacteriology in Guangzhou Municipal Chest Hospital between January 2014 and December 2014 were included as the subjects in the study,including 150 bronchiectasis complicated with NTM pulmonary disease（ 64 underwent IGRAs） and 284 bronchiectasis complicated with pulmonary TB（ 71 underwent IGRAs）. The IGRAs results of bronchiectasis complicated with NTM pulmonary disease and bronchiectasis complicated with TB were retrospectively analyzed. Results： The sensitivity（ Se） and specificity（ Sp） of IGRAs in the differential diagnosis of bronchiectasis complicated with NTM pulmonary disease and bronchiectasis with pulmonary TB was 95. 77%（ 68 /71,95% CI： 93. 3%-97. 3%） and 92. 19%（ 59 /64,95% CI： 87. 4%-95. 2%）,respectively. The positive predictive value（ PPV） and positive likelihood ratio（ ＋LR） of IGRAs was 93. 15%（ 68 /73,95% CI： 89. 3%-95. 7%） and 12. 259（ 95% CI： 5. 276-28. 483）,respectively. The negative predictive value（ NPV） and negative likelihood ratio（- LR） was 95. 16%（ 59 /62,95% CI： 92. 1%- 97. 1%） and 0. 0458（ 95% CI： 0. 0151-0. 139）,respectively. There were statistically significant differences in the qualitative comparison（ χ2= 101. 357,P = 0. 000）,quantative comparison of ESAT-6（ A hole） spot number（ t =- 8. 104,P = 0. 000） and CFP-10（ B hole） spot number（ t =- 11. 193,P= 0. 000） between NTM group and TB group（ all P〈0. 05）. Conclusion： Patients with bronchiectasis complicated with mycobacteria pulmonary disease can be early,quickly,noninvasively and accurately diagnosed as bronchiectasis complicated with NTM pulmonary disease or pulmonary TB by IGRAs,which has guiding significance for clinical diagnosis and treatment.