全血γ-干扰素释放试验对活动性结核病的辅助诊断价值研究

Evaluation of Interferon Gamma Release Assay in the Diagnosis of Pulmonary Tuberculosis

目的探讨全血γ-干扰素释放试验（QFT-GIT）对活动性结核病的辅助诊断价值。方法前瞻性纳入2012年6月至2014年12月期间在首都医科大学附属北京胸科医院收治的疑似活动性结核病住院患者593例[获得性免疫缺陷病毒（HIV）阴性，年龄〉16岁]，剔除其中诊断不明确患者84例（14．2%）。将入选的509例患者分为两组：结核组322例（其中菌阴肺结核229例）和其他肺部疾病组187例。对所有患者的外周全血进行QFT-GIT检测，分析其诊断效能。结果22例（4．3％）患者QFT-IT结果为不确定，受年龄因素影响。菌阳和菌阴肺结核患者中QFT-GIT的阳性率分别为89．0％和81．9％，二者之间差异无统计学意义（χ^2=2．384，P〉0．05）。QFT-GIT总的敏感度为84．0％、特异度为62．2％、阳性预测值为79．1％、阴性预测值为69.6％、阳性似然比为2．230和阴性似然比为0．257。结论QFT-GIT对结核病辅助诊断有一定的价值，尤其对菌阴肺结核的诊断有一定意义。

Objective To evaluate the value of interferon gamma release assay, QuantiFERON-TB Gold In-Tube （QFT-GIT） in the diagnosis of pulmonary tuberculosis. Methods From June 2012to December 2014, aprospective study was undertaken at Beijing Chest Hospital, Capital Medical University. Atotal of 593 patients with suspected pulmonary tuberculosis [human immunodeficiency virus （HIV） negative, age≥16 years old]were enrolled and 84 （14.2%） patients were excluded for uncertain diagnosis. Of the 509 patients were divided into two groups： 322 tuberculosis （including 229 bacteriological-negative TB） and 263 non-tuberculosis groups. Each patient was tested by QFT-GIT on peripheral blood and the diagnostic performance of QFT-GIT inpulmonary tuberculosis were analyzed according to the final diagnosis. Results Of 22 patients （4.3%） with indeterminate test results, agewas associated with the rate of indeterminate test results. The positive rate of QFT-GIT in bacteriological-positive and bacteriological-negative pulmonary tuberculosis were 89.0% and 81.9%, there was no ignificant difference between them（ χ^2=2.384, P 〉0.05）. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the QFT-GIT were 84.0%, 62.2%, 79.1%, 69.6%, 2.23 and 0.257, respectively. Conclusions QFT-GIT may be a more accurate approach for the diagnosis of active tuberculosis, offers more basis for the diagnosis of smear negative tuberculosis.