两种γ-干扰素释放试验在结核性胸膜炎中的辅助诊断价值

Comparison of two interferon-gamma release assay for diagnosis of tuberculous pleurisy

目的评价基于外周血单个核细胞的酶联免疫斑点试验(T-SPOT.TB)和基于全血的酶联免疫吸附试验(Quanti FERON-TB Gold in-tube,QFT-GIT)在结核性胸膜炎中的辅助诊断价值。方法收集2016年12月至2017年12月在首都医科大学附属北京胸科医院住院确诊的胸腔积液患者60例(除临床诊断和未确诊病例122例),其中结核性胸膜炎37例(结核组),非结核性胸膜炎23例(对照组),同时行胸腔积液和外周血T-SPOT.TB和QFT-GIT检测。结果胸腔积液和外周血中,结核组T-SPOT.TB斑点形成细胞(spot forming cell,SFC)数与QFT-GIT检测的IFN-γ释放量值均明显高于对照组,差异均有统计学意义(P<0.01);结核组中胸腔积液T-SPOT.TB检测的SFC数显著高于外周血SFC数,差异有统计学意义(P<0.01)。胸腔积液T-SPOT.TB检测的ROC曲线下面积(AUC)为0.932,高于外周血QFT-GIT检测(0.874)、外周血T-SPOT.TB检测(0.855)和胸腔积液QFT-GIT检测(0.779)。胸腔积液T-SPOT.TB检测中不确定结果比例(16.7%)显著低于QFT-GIT(46.7%),差异均有统计学意义(P<0.01)。结论 T-SPOT.TB检测方法更适用于胸腔积液的检测,可辅助结核性胸膜炎的早期诊断。

Objective To evaluate the performance of two interferon-gamma release assays （T-SPOT.TB and QFT- GIT） for diagnosis of tuberculous pleurisy. Methods From Dec 2016 to Dec 2017, 60 patients in Beijing Chest Hospital were enrolled and categorized as tuberculous pleurisy （TB group, n=37） and non-tuberculous pleurisy （NTB group, n=23）, the remaining inconclusive TB and clinical diagnosis TB （n= 122） were excluded from final analysis. T-SPOT.TB and QFT- GIT on pleural fluid were performed in paralleled with peripheral blood. Results Both the SFCs and the concentration of IFN-γ were significantly higher in the TB group than those in the NTB group. In the TB group, there was a significant difference between SFCs using T-SPOT.TB in pleural fluid and peripheral blood. The area under the ROC curve （AUC） of pleural fluid T-SPOT.TB test was 0.932, which was higher than peripheral blood QFT-GIT （0.874）, peripheral blood T-SPOT.TB （0.855） and pleural fluid QFT-GIT （0.779）. Less indeterminate results were detected in pleural fluid T-SPOT.TB test （16.7%） than that in pleural fluid QFT-GIT test （46.7%, P 〈 0.01）. Conclusion T-SPOT.TB test is better than QFT- GIT test on pleural fluid as a useful adjunctive tool for diagnosis of tuberculous pleurisy.