T淋巴细胞γ-干扰素释放试验在结核病诊断中的应用研究

Clinical application value of the interferon gamma release assay of T lymphocyte in tuberculosis

目的探讨结核感染T淋巴细胞γ-干扰素释放试验(TB-IGRAs)用于结核病诊断的研究。方法回顾性分析医院2016年1-9月呼吸内科收治的疑似结核病患者207例,收集疑似结核病患者的TB-IGRAs结果和临床特征等资料;207例疑似结核病患者分为三组进行研究,检测卡介苗纯蛋白衍生物试验(PPD)阳性加做TBIGRAs为PPD阳性检测组75例;检测PPD阴性加做TB-IGRAs为PPD阴性检测组50例;直接检测TB-IGRAs为直接检测组82例;对三组研究病例TB-IGRAs的结果进行比较分析。结果 207例疑似结核患者,131例出院诊断为结核病,PPD阳性检测组TB-IGRAs检测阳性率为76.20%,高于PPD阴性检测组50%(P<0.05);PPD阳性检测组高于直接检测组75%,但差异无统计学意义;直接检测组高于PPD试验阴性检测组(P<0.05);与PPD阳性检测组比较,直接检测组检测阳性率比较差异无统计学意义;与PPD阴性检测组比较,PPD试验阳性检测组、直接检测组阳性率比较差异有统计学意义(P<0.05);PPD阳性检测组TB-IGRAs检测灵敏度为94.10%,特异性为37.50%,AUC为0.67;直接检测组TB-IGRAs检测灵敏度为66.70%,特异性为73.00%,AUC为0.74。结论 PPD试验阳性加做TB-IGRAs可提高结核病的检测灵敏度;PPD试验阳性加做TBIGRAs在结核病的阳性分布与患者直接检测TB-IGRAs无区别;ROC曲线显示TB-IGRAs在结核病中诊断效率低。

OBJECTIVE To investigate the value of interferon gamma release assay of T lymphocyte（TB-IGRA）for the diagnosis of tuberculosis.METHODS A total of 207 cases of TB suspects from respiration department of Shaoxing Municipal Hospital from Jan.2016 to Sep.2016 were retrospectively analyzed.TB-IGRAs results and clinical features of suspected TB patients were collected.These patients were divided into BCG pure protein derivate test positive detection group（n=75）with PPD positive and TB-IGRAs examination,PPD negative detection group（n=50）with PPD negative and TB-IGRAs examination,and direct detection group（n=82）with direct TB-IGRAs examination.TB-IGRAs results of the three groups were compared and analyzed.RESULTS There were 131 patients who were finally confirmed as tuberculosis in 207 cases of TB suspects.The positive rate of TB-IGRA in PPD positive detection group 76.20% was higher than that of PPD negative detection group 50% （P〈0.05）,PPD positive detection group was higher than that of direct detection group 75% （P〈0.05）,and direct detection group was higher than that of PPD negative detection group（P〈0.05）,while there was no significant difference between PPD positive detection group and direct detection group.Compared with PPD negative detection group,the positive rate of PPD positive detection group and direct detection group had significant difference（P〈0.05）.The sensitivity of TB-IGRA for PPD positive detection group was 94.10% ,specificity was 37.50% ,and the area under ROC curve（AUC）was 0.67.The sensitivity of TB-IGRA for direct detection group was 66.70% ,specificity was73.00% ,and AUC was 0.74.CONCLUSION The TB suspected patients with PPD positive reaction plus TBIGRA detection can improve the detection sensitivity of TB.The positive PPD plus TB-IGRAs and direct detection of TB-IGRAs have no difference in the positive distribution of TB.The ROC curve shows that TB-IGRAs is inefficient in diagnosis of tuberculosis.