干扰素体外释放酶联免疫法在孤立性肺结节诊断中的价值

Diagnostic value of quantitative diagnostic kit for Mycobacterium tuberculosis interferon-γrelease assay in patients with solitary pulmonary nodule

目的评价干扰素体外释放酶联免疫法(TB-IGRA)在以孤立性肺结节病灶为主要表现的结核病中的临床应用价值。方法选取60例经病理确诊为结核病和90例确诊为肺恶性肿瘤的肺内孤立性结节患者,作为结核组和非结核组。采用TB-IGRA检测结核感染T细胞的IFN-γ释放量,同时对患者进行结核菌素皮肤试验(TST)。以病理结果作为金标准,对TB-IGRA和TST的检测结果进行分析,绘制受试者工作特征(ROC)曲线,比较两种方法的诊断价值。结果TB-IGRA检测结核的灵敏度为80.0%,特异度为87.78%,阳性预测值为81.36%,阴性预测值为86.81%,均显著高于TST(P<0.001),ROC曲线下面积为0.923(95%CI:0.881~0.964)。结核组的IFN-γ释放量明显高于非结核组(P<0.001)。结论 IGRA在判定肺结节病灶是否为结核病方面的准确性明显优于TST。

Objective To evaluate the clinical value of quantitative diagnostic kit for Mycobacterium tuberculosis interferon-γ （IFN-γ） release assay in patients with solitary pulmonary nodule. Methods A total of 60 patients with solitary pulmonary nodules diagnosed as tuberculosis and 90 patients with solitary pulmonary nodules diagnosed as pulmonary malignant tumors were analyzed retrospectively in the study. All cases were divided into tuberculosis group and non-tuberculosis group. In vitro release of IFN-γ was detected by quantitative diagnostic kit for Mycobacterium tuberculosis IFN-γ release assay （TB-IGRA） and tuberculin skin test （TST） were performed in all cases. Pathological results were regarded as gold standard for the final diagno- sis of the lesions. The results of TB-IGRA were compared with TST, and the receiver operating characteristic （ROC） curve was used to evaluate the diagnostic value of the above two methods. Results The sensitivity of TP,-IGRA test in detection of tuberculosis was 80.0%, the specificity was 87.78%, the positive predictive value was 81.36% and the negative predictive value was 86.81%, which were significantly better than those of TST （P〈0. 001）. The area under ROC curve was 0. 923 （95%CI： 0. 881-0. 964）. The release of IFN-γ in the tuberculosis group was significantly higher than that in the non-tuberculosis group （P〈0. 001）. Conclusion The accuracy of TB-IGRA detection in patients with solitary pulmonary nodules was significantly better than that of TST in the determination of whether the nodule was tuberculosis, which provides a high clinical application value.