γ-干扰素释放试验诊断活动性结核病分析

Gamma-Interferon Release Test for the Diagnosis of Active Tuberculosis

目的研究γ-干扰素释放试验(IGRA)诊断活动性结核病敏感性、γ-干扰素释放水平的影响因素及诊断价值。方法搜集2012-10/2015-08期间某院279例活动性结核病患者住院资料。按年龄、部位、PPD与TB-Ab实验结果分组进行IGRA定性、全血γ-干扰素定量检测。比较组间IGRA敏感性、γ-干扰素水平差异,并与PPD、TB-Ab、ADA、ESR检测敏感性比较,分析IGRA在诊断活动性结核病中的影响因素及价值。结果 IGRA敏感性:淋巴结核100%活动性结核病为88.53%、结核性脑膜炎最低64%,其余部位结核病均>87%;全血γ-干扰素水平:活动性结核病为593.18±1258.26 pg/m L,肺结核最高1372.09±2257.22 pg/m L,结核性脑膜炎最低190.57±535.53pg/m L;PPD阳性组IGRA敏感性、γ-干扰素水平均高于PPD阴性组;IGRA敏感性与年龄无关,γ-干扰素水平中青年高于老年人;IGRA敏感性、γ-干扰素水平与TB-Ab试验结果无相关性。结论 IGRA敏感性、γ-干扰素释放水平与机体的细胞免疫、结核病部位相关,IGRA是活动性结核病辅助诊断中高敏感性指标,对结核病的诊断具有较高价值。

Objective To study the sensitivity and value of interferon gamma release test （IGRA） in the diagnosis of active tuberculosis and factors influencing the interferon gamma release. Methods Data of 279 patients with active tuberculosis hospitalized during the period from October 2012 to August 2015 were collected. According to the age, position, PPD and TB -Ab experimental results, patients were grouped for qualitative analysis of IGRA and quantitative analysis of whole blood gamma interferon. The IGRA sensitivity and gamma interferon levels of the two groups were compared ; the PPD, TB - Ab, ADA and ESR detection sensitivities were compared to analyze the influencing factors and the value of IGRA in the diagnosis of active tuberculosis. Results IGRA sensitivity was 88.53%, 64%, 100% and more than 87% for active tuberculosis, tuberculous meningitis, lymph tuberculosis and tuberculosis of other parts, respectively. Whole blood gamma interferon levels were 593.18 ± 1258.26 pg/mL in active tuberculosis, the highest was in pulmonary tuberculosis （1372. 09 ±2257.22 pg/mL） and the lowest was in tuberculous meningitis （ 190.57 ± 535.53 pg/mL）, re-spectively. The IGRA sensitivity and gamma interferon level were higher in the PPD positive group than in the PPD negative group; IGRA sensitivity was independent of age, and gamma interferon levels were higher in young and middle -aged people than in aged people;